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NPI Code Detail

MEDICARE: KAVON SAMET SHIRVANI

MEDICARE: KAVON SAMET SHIRVANI
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
1225100000XPhysical Therapist304213CA

General Provider Information

NPI Number : 1912760562
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAVON SAMET SHIRVANI
Provider Business Mailing Address
First Line : 35 SORENSON
Second Line :
City : IRVINE
State : CA
Zip : 92602-1644
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15000 KENSINGTON PARK DR
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1830
Country : US
Telephone Number : 657-859-6458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2024
Last Update Date : 02/05/2024

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Directions to “ KAVON SAMET SHIRVANI ” Practice Location

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