Provider Demographics
NPI:1154424232
Name:MESBAHI, KAVOOS NOORI (MD)
Entity type:Individual
Prefix:DR
First Name:KAVOOS
Middle Name:NOORI
Last Name:MESBAHI
Suffix:
Gender:
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:PO BOX 3036
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-9036
Mailing Address - Country:US
Mailing Address - Phone:703-257-2070
Mailing Address - Fax:703-257-2072
Practice Address - Street 1:10535 CRESTWOOD DR
Practice Address - Street 2:101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4416
Practice Address - Country:US
Practice Address - Phone:703-257-2070
Practice Address - Fax:703-257-2072
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037826208C00000X, 208000000X, 208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7310021Medicaid
VA7310021Medicaid
VA183413Medicare PIN