Provider Demographics
NPI:1093773764
Name:KIRVEN, FELIX MOSES
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:MOSES
Last Name:KIRVEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 CLEVELAND STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-963-6507
Mailing Address - Fax:757-963-6375
Practice Address - Street 1:5701 CLEVELAND STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-963-6507
Practice Address - Fax:757-963-6375
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA179191OtherBLUE CROSS BLUESHIELD
VA010208874Medicaid
VA00W605K47Medicare ID - Type Unspecified