Provider Demographics
NPI:1134457161
Name:KIDANE, TEWODROS ASSEFA (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:TEWODROS
Middle Name:ASSEFA
Last Name:KIDANE
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Gender:M
Credentials:MD, MSC
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Mailing Address - Street 1:155 N FRESNO ST
Mailing Address - Street 2:FAMILY & COMMUNITY MEDICINE DEPARTMENT
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2302
Mailing Address - Country:US
Mailing Address - Phone:559-499-6450
Mailing Address - Fax:559-499-6451
Practice Address - Street 1:155 N FRESNO ST
Practice Address - Street 2:FAMILY & COMMUNITY MEDICINE DEPARTMENT
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2302
Practice Address - Country:US
Practice Address - Phone:559-499-6450
Practice Address - Fax:559-499-6451
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2021-12-15
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Provider Licenses
StateLicense IDTaxonomies
CAA110208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine