Individual
DR. KEVIN TEHRANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
560 NORTHERN BLVD, GREAT NECK, GREAT NECK, NY 11021-5100
(516) 498-9790
(516) 498-9796
Mailing address
560 NORTHERN BLVD, GREAT NECK, GREAT NECK, NY 11021-5100
(516) 498-9790
(516) 498-9796
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
214939
NY
208200000X
Plastic Surgery Physician
214939
NY
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
214939
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02463385
—
NY
01
—
214939
LISENCE NUMBER
NY
01
—
N84003
ACS HEAT NET PROVIDER ID
NY
01
—
P2995192
OXFORD PROVIDER ID
NY
Enumeration date
09/28/2006
Last updated
06/26/2013
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