Provider Demographics
NPI:1174509418
Name:SHAHI, KAVIAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KAVIAN
Middle Name:
Last Name:SHAHI
Suffix:
Gender:M
Credentials:MD, PHD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3043
Mailing Address - Country:US
Mailing Address - Phone:916-771-3300
Mailing Address - Fax:916-771-3443
Practice Address - Street 1:1301 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-771-3300
Practice Address - Fax:916-771-3443
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86147207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS5145734OtherDEA
H43912Medicare UPIN
BS5145734OtherDEA