Provider Demographics
NPI:1396004594
Name:KAVEESHVAR, HIRSH (DO)
Entity Type:Individual
Prefix:DR
First Name:HIRSH
Middle Name:
Last Name:KAVEESHVAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10787 WILSHIRE BLVD APT 703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7340
Mailing Address - Country:US
Mailing Address - Phone:248-933-0323
Mailing Address - Fax:
Practice Address - Street 1:23861 MCBEAN PKWY STE B18
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4456
Practice Address - Country:US
Practice Address - Phone:661-288-7978
Practice Address - Fax:661-288-7903
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010199622084P2900X, 208VP0014X
390200000X
CA20A152122084S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program