Provider Demographics
NPI:1629008909
Name:ESMAEILI, KEYVAN (MD)
Entity Type:Individual
Prefix:
First Name:KEYVAN
Middle Name:
Last Name:ESMAEILI
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 1:2840 LONG BEACH BLVD
Mailing Address - Street 2:130
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1516
Mailing Address - Country:US
Mailing Address - Phone:562-424-8111
Mailing Address - Fax:562-492-6830
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:130
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1516
Practice Address - Country:US
Practice Address - Phone:562-424-8111
Practice Address - Fax:562-492-6830
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72887208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH65731Medicare UPIN