1649271990 NPI number — KIANOOSH KAVEH DO PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649271990 NPI number — KIANOOSH KAVEH DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIANOOSH KAVEH DO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649271990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3221 TAMIAMI TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33952-8002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-505-8720
Provider Business Mailing Address Fax Number:
941-505-8747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3221 TAMIAMI TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-8002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-505-8720
Provider Business Practice Location Address Fax Number:
941-505-8747
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAVEH
Authorized Official First Name:
KIANOOSH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-505-8720

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  OS8229 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2142967000 . This is a "AMERIHEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2148967000 . This is a "INDEPENDENCE BC PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2985402 . This is a "AETNA BLUE BELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 24133 . This is a "BCBS FL GRP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 471501 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651256 . This is a "COMBINED INS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0323474 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 30030181 . This is a "KEYSTONE MERCY HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N279248 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001457915 . This is a "BCBS HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9814293 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 265580200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000ZCY746 . This is a "BCBS MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7405063 . This is a "MAMSI INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: KKA150339 . This is a "BCBS EXCELLUS NY" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com