MEDICARE: KIAN KAVEH D.O INC

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	207R00000X	Internal Medicine Physician	718	NV

General Provider Information

NPI Number	:	1497996292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIAN KAVEH D.O INC

Provider Business Mailing Address
First Line	:	5875 S RAINBOW BLVD
Second Line	:	SUITE 203
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2554
Country	:	US
Telephone Number	:	702-804-0211
Fax Number	:	702-853-4215

Provider Business Practice Location Address
First Line	:	5875 S RAINBOW BLVD
Second Line	:	SUITE 203
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2554
Country	:	US
Telephone Number	:	702-804-0211
Fax Number	:	702-853-4215

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. KIAN KAVEH
Credential	:	D.O
Telephone Number	:	702-804-0211

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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