Provider Demographics
NPI:1033807961
Name:LARI, KIAN BANIZAMAN (MD)
Entity Type:Individual
Prefix:
First Name:KIAN
Middle Name:BANIZAMAN
Last Name:LARI
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 1:1001 S CHURCH ST UNIT 105
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3720
Mailing Address - Country:US
Mailing Address - Phone:864-201-0015
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:ROOM 1017, CB # 7600
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:783-398-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLARI-TDU8S8390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program