Provider Demographics
NPI:1326445347
Name:KAVEH-TALLEY, MOJGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:KAVEH-TALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MOJGAN
Other - Middle Name:
Other - Last Name:KAVEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5100 NORTH PIEDRAS STREET
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930
Mailing Address - Country:US
Mailing Address - Phone:915-564-6100
Mailing Address - Fax:
Practice Address - Street 1:5100 NORTH PIEDRAS STREET
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930
Practice Address - Country:US
Practice Address - Phone:915-564-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-18277207R00000X
FL117312207R00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174H00000XOther Service ProvidersHealth Educator