Provider Demographics
NPI:1063788446
Name:KAVOUSSI, SHAHEEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHEEN
Middle Name:
Last Name:KAVOUSSI
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 1:2117 DEL MONTE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3517
Mailing Address - Country:US
Mailing Address - Phone:713-725-8012
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 1812
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2775
Practice Address - Country:US
Practice Address - Phone:832-306-3209
Practice Address - Fax:832-356-5462
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292289-1207W00000X
IN01081778A207W00000X
CAA154904207W00000X
TXQ4439207WX0107X, 207W00000X
TXBP10041058390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347100509Medicaid
TX347100507Medicaid
TX347100508Medicaid