Provider Demographics
NPI:1295888022
Name:HAYAVI, KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HAYAVI
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:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-0108
Mailing Address - Country:US
Mailing Address - Phone:310-975-1885
Mailing Address - Fax:866-586-9678
Practice Address - Street 1:15630 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3141
Practice Address - Country:US
Practice Address - Phone:818-817-0600
Practice Address - Fax:866-586-9678
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA703652086S0127X, 208VP0014X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA70365OtherSTATE LICENSE NUMBER
CAA70365OtherSTATE LICENSE NUMBER
CABH8270047OtherDEA REGISTRATION NUMBER
CAA70365OtherSTATE LICENSE NUMBER