1346332301 NPI number — DR. KEVIN TEHRANI M.D.

Table of content: DR. KEVIN TEHRANI M.D. (NPI 1346332301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346332301 NPI number — DR. KEVIN TEHRANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEHRANI
Provider First Name:
KEVIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TEHRANI
Provider Other First Name:
KAYVON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346332301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 NORTHERN BLVD
Provider Second Line Business Mailing Address:
GREAT NECK
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-498-9790
Provider Business Mailing Address Fax Number:
516-498-9796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
GREAT NECK
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-498-9790
Provider Business Practice Location Address Fax Number:
516-498-9796
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  214939 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 214939 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208200000X , with the licence number: 214939 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 214939 . This is a "LISENCE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2995192 . This is a "OXFORD PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N84003 . This is a "ACS HEAT NET PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02463385 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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