Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20A10932 | CA |
N | 111NI0900X | Internist | 20A10932 | CA |
Y | 207RP1001X | Pulmonary Disease | 20A10932 | CA |
NPI | 1003140922 |
---|---|
Provider Name | Dr. Kaveh N Rezvan |
First Address | San Juan Capistrano, CA 92675-1585 |
Second Address | San Juan Capistrano, CA 92675-1585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2009 |
Last Update Date | 21/01/2020 |