Basic Information
| Provider Information | |||||||||
| NPI: | 1720387558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAVAHERI | ||||||||
| FirstName: | KIANOUSH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 FIR ST | ||||||||
| Address2: | SHARP REES-STEALY MEDICAL GROUP | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 FIR ST | ||||||||
| Address2: | SHARP REES-STEALY MEDICAL GROUP | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2011 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A 116084 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.