MEDICARE: LORIE KAVAFYAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		CA
2	207R00000X	Internal Medicine Physician	20A14532	CA

General Provider Information

NPI Number	:	1326468620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE KAVAFYAN D.O.

Provider Business Mailing Address
First Line	:	12660 RIVERSIDE DR STE 215
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607-3430
Country	:	US
Telephone Number	:	818-487-0040
Fax Number	:	818-487-0051

Provider Business Practice Location Address
First Line	:	12660 RIVERSIDE DR STE 215
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607-3430
Country	:	US
Telephone Number	:	818-487-0040
Fax Number	:	818-487-0051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	03/29/2023

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