Provider Demographics
NPI:1942499785
Name:KIAN KAVEH DO PC
Entity Type:Organization
Organization Name:KIAN KAVEH DO PC
Other - Org Name:MOUNTAINVIEW FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-944-2225
Mailing Address - Street 1:2451 HOLLOW ROCK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1510
Mailing Address - Country:US
Mailing Address - Phone:702-755-5757
Mailing Address - Fax:
Practice Address - Street 1:2901 N TENAYA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1404
Practice Address - Country:US
Practice Address - Phone:702-944-2225
Practice Address - Fax:702-944-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV718207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF65989Medicare UPIN