Provider Demographics
NPI:1306912720
Name:HAGHIGHI, KAYVON (DDS, MD, FACS)
Entity type:Individual
Prefix:DR
First Name:KAYVON
Middle Name:
Last Name:HAGHIGHI
Suffix:
Gender:M
Credentials:DDS, MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2003
Mailing Address - Country:US
Mailing Address - Phone:732-530-1110
Mailing Address - Fax:732-530-5103
Practice Address - Street 1:276 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2003
Practice Address - Country:US
Practice Address - Phone:732-530-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021929001223S0112X
NJ25MA073520001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH76782Medicare UPIN