Provider Demographics
NPI:1144541764
Name:AKHBARI, KAVEH (DPM)
Entity type:Individual
Prefix:DR
First Name:KAVEH
Middle Name:
Last Name:AKHBARI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:KAVEN
Other - Middle Name:
Other - Last Name:AKHBARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80 WEST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:408-842-0281
Mailing Address - Fax:408-848-4341
Practice Address - Street 1:80 WEST 5TH ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-842-0281
Practice Address - Fax:408-848-4341
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAE5062213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5062OtherLICENSE
CA1144541764OtherNPI
CA1144541764OtherNPI