Provider Demographics
NPI:1346774643
Name:KARIMIGALOUGAHI, KEYVAN
Entity Type:Individual
Prefix:DR
First Name:KEYVAN
Middle Name:
Last Name:KARIMIGALOUGAHI
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:E305/599 PACIFIC HIGHWAY
Mailing Address - Street 2:ST LEONARDS
Mailing Address - City:SYDNEY
Mailing Address - State:NSW
Mailing Address - Zip Code:2065
Mailing Address - Country:AU
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-2708
Practice Address - Fax:212-342-3660
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program