Provider Demographics
NPI:1679137160
Name:MOAZAM, KAYVON (DO)
Entity Type:Individual
Prefix:
First Name:KAYVON
Middle Name:
Last Name:MOAZAM
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 1:9201 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3332
Mailing Address - Country:US
Mailing Address - Phone:623-327-5105
Mailing Address - Fax:623-327-5437
Practice Address - Street 1:9201 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3332
Practice Address - Country:US
Practice Address - Phone:623-327-7313
Practice Address - Fax:623-327-5437
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009840208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist