Basic Information
| Provider Information | |||||||||
| NPI: | 1003140922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REZVAN | ||||||||
| FirstName: | KAVEH | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 30230 RANCHO VIEJO RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926751585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494434303 | ||||||||
| FaxNumber: | 9494434033 | ||||||||
| Practice Location | |||||||||
| Address1: | 30230 RANCHO VIEJO RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926751585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494434303 | ||||||||
| FaxNumber: | 9494434033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2009 | ||||||||
| LastUpdateDate: | 01/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20A10932 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 20A10932 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.