Provider Demographics
NPI:1699041970
Name:GOLSHANI, KEVIN REZA (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:REZA
Last Name:GOLSHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KAYVON
Other - Middle Name:REZA
Other - Last Name:GOLSHANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7455 W WASHINGTON AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4356
Mailing Address - Country:US
Mailing Address - Phone:702-878-0393
Mailing Address - Fax:702-902-4580
Practice Address - Street 1:1505 WIGWAM PKWY STE 330
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8195
Practice Address - Country:US
Practice Address - Phone:702-878-0393
Practice Address - Fax:702-902-4634
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA269854207X00000X
NV17929207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1699041970Medicaid