Provider Demographics
NPI:1003140922
Name:REZVAN, KAVEH N (DO)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:N
Last Name:REZVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30230 RANCHO VIEJO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1585
Mailing Address - Country:US
Mailing Address - Phone:949-443-4303
Mailing Address - Fax:949-443-4033
Practice Address - Street 1:30230 RANCHO VIEJO RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1585
Practice Address - Country:US
Practice Address - Phone:949-443-4303
Practice Address - Fax:949-443-4033
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10932207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine