Provider Demographics
NPI:1710083753
Name:REZAIE, KAMBIZ KEVIN (MD)
Entity Type:Individual
Prefix:MR
First Name:KAMBIZ
Middle Name:KEVIN
Last Name:REZAIE
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 1:24711 CALLE LARGO
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3014
Mailing Address - Country:US
Mailing Address - Phone:818-223-1405
Mailing Address - Fax:
Practice Address - Street 1:24711 CALLE LARGO
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3014
Practice Address - Country:US
Practice Address - Phone:818-223-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87657208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics