Provider Demographics
NPI:1003851965
Name:KAVIANI, KIAN (MD)
Entity Type:Individual
Prefix:
First Name:KIAN
Middle Name:
Last Name:KAVIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 FERNWWOD RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-493-6578
Mailing Address - Fax:301-493-9282
Practice Address - Street 1:10215 FERNWWOD RD
Practice Address - Street 2:SUITE 315
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-493-6578
Practice Address - Fax:301-493-9282
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0K88KOtherBLUE CROSS BLUE SHIELD
887102OtherMAMSI HMO
287102OtherMAMSI APO
MD090804500Medicaid
H05663Medicare UPIN
490484Medicare ID - Type Unspecified