Provider Demographics
NPI:1346485919
Name:KARANDISH, KAVEH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:KARANDISH
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 1:2801 E COAST HWY STE E
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2231
Mailing Address - Country:US
Mailing Address - Phone:949-242-9166
Mailing Address - Fax:480-837-6804
Practice Address - Street 1:2801 E COAST HWY STE E
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2231
Practice Address - Country:US
Practice Address - Phone:949-242-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46491207R00000X
FL103915207R00000X
390200000X
CAC168905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC168905OtherMEDICAL LICENSE