Provider Demographics
NPI:1033110861
Name:KYAZZE, FRED BOYD (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:BOYD
Last Name:KYAZZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 W. ALONDRA BLVD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3533
Mailing Address - Country:US
Mailing Address - Phone:310-637-3680
Mailing Address - Fax:310-637-3679
Practice Address - Street 1:1410 W. ALONDRA BLVD.
Practice Address - Street 2:SUITE C
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3533
Practice Address - Country:US
Practice Address - Phone:310-637-3680
Practice Address - Fax:310-637-3679
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine