Provider Demographics
NPI:1124243563
Name:AMINI, KAYVAN (DO)
Entity type:Individual
Prefix:
First Name:KAYVAN
Middle Name:
Last Name:AMINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-499-9515
Mailing Address - Fax:954-499-7877
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 403
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-499-9515
Practice Address - Fax:954-499-7877
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00901578OtherMEDICARE RAIL ROAD
FL279226500Medicaid
FLAE211UMedicare PIN