Provider Demographics
NPI:1275549552
Name:KEYHANI, KAYVAN (MD)
Entity Type:Individual
Prefix:
First Name:KAYVAN
Middle Name:
Last Name:KEYHANI
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 1:3535 HILL BLVD STE R
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1209
Mailing Address - Country:US
Mailing Address - Phone:914-245-3303
Mailing Address - Fax:914-245-3531
Practice Address - Street 1:3535 HILL BLVD STE R
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1209
Practice Address - Country:US
Practice Address - Phone:914-245-3303
Practice Address - Fax:914-245-3531
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222645-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00701413OtherRAILROAD MEDICARE
NY02622728Medicaid
VT1010634Medicaid
NY02622728Medicaid
VT1010634Medicaid
VTVN3432Medicare ID - Type Unspecified