Basic Information
| Provider Information | |||||||||
| NPI: | 1104919570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILANI | ||||||||
| FirstName: | KAVIAN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9401 LEE HWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220311849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033834836 | ||||||||
| FaxNumber: | 7039978685 | ||||||||
| Practice Location | |||||||||
| Address1: | 9401 LEE HWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220311849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033834836 | ||||||||
| FaxNumber: | 7033834911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101057147 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5633320 | 05 | VA | MEDICAID |