Provider Demographics
NPI:1104923572
Name:SOLEIMANPOUR, KAVEH (MD)
Entity type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:SOLEIMANPOUR
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 1:3949 LOS FELIZ BLVD.
Mailing Address - Street 2:APT. 611
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2324
Mailing Address - Country:US
Mailing Address - Phone:323-661-6961
Mailing Address - Fax:323-664-6506
Practice Address - Street 1:3949 LOS FELIZ BLVD.
Practice Address - Street 2:APT. 611
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2324
Practice Address - Country:US
Practice Address - Phone:323-661-6961
Practice Address - Fax:323-664-6506
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA916402085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD034705OtherMEDICAL LICENSE NUMBER
CAA91640OtherMEDICAL LICENSE NUMBER
PAMD424373OtherMEDICAL LICENSE NUMBER