Provider Demographics
NPI:1558492124
Name:KARDOONI, KAVEH (DO)
Entity Type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:KARDOONI
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:702-759-8600
Mailing Address - Fax:702-384-1815
Practice Address - Street 1:2020 PALOMINO LN
Practice Address - Street 2:# 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4894
Practice Address - Country:US
Practice Address - Phone:702-759-8600
Practice Address - Fax:702-384-1815
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN522632085R0202X
390200000X
NVDO16082085R0202X
KYR09652085R0202X
NY2570312085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200468650AMedicaid
NV1558492124Medicaid
MN300005425Medicaid
AZ624236Medicaid
NVP01168761OtherRR MEDICARE
CA1558492124Medicaid
IAENROLLEDMedicaid
NY03227790Medicaid
OK200468650AMedicaid
NVFH770YMedicare PIN
MN300005425Medicaid
AZ624236Medicaid
NY03227790Medicaid