Provider Demographics
NPI:1851385447
Name:KAVEH, SASSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SASSAN
Middle Name:
Last Name:KAVEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 NORTH TENAYA WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0461
Mailing Address - Country:US
Mailing Address - Phone:702-233-6661
Mailing Address - Fax:702-233-3055
Practice Address - Street 1:3150 NORTH TENAYA WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0461
Practice Address - Country:US
Practice Address - Phone:702-233-6661
Practice Address - Fax:702-233-3055
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8320207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1851385447Medicaid
NVV37009Medicare PIN
NV1851385447Medicaid