Provider Demographics
NPI:1073777413
Name:ALI KIA MD INC
Entity Type:Organization
Organization Name:ALI KIA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-648-2383
Mailing Address - Street 1:2540 S MARYLAND PKWY
Mailing Address - Street 2:#196
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1627
Mailing Address - Country:US
Mailing Address - Phone:909-648-2383
Mailing Address - Fax:702-478-7263
Practice Address - Street 1:2470 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5200
Practice Address - Country:US
Practice Address - Phone:702-737-1427
Practice Address - Fax:702-478-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty