MEDICARE: ASHKHAN NICHOLAS KAVIANI

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	363AM0700X	Medical Physician Assistant
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1720321318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHKHAN NICHOLAS KAVIANI

Provider Business Mailing Address
First Line	:	7301 MEDICAL CENTER DRIVE
Second Line	:	SUITE 400
City	:	WEST HILLS
State	:	CA
Zip	:	91307
Country	:	US
Telephone Number	:	818-264-3344
Fax Number	:	818-264-3433

Provider Business Practice Location Address
First Line	:	7301 MEDICAL CENTER DR STE 400
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1988
Country	:	US
Telephone Number	:	818-264-3344
Fax Number	:	818-264-3433

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	12/15/2021

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