Provider Demographics
NPI:1871980136
Name:NEMATI, KIAVOUSH (MD)
Entity type:Individual
Prefix:DR
First Name:KIAVOUSH
Middle Name:
Last Name:NEMATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KIAVASH
Other - Middle Name:
Other - Last Name:NEMATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 847969
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-7969
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-340-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134634207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology