Provider Demographics
NPI:1154311355
Name:KIA, NAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAVID
Middle Name:
Last Name:KIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6423
Mailing Address - Country:US
Mailing Address - Phone:773-755-1111
Mailing Address - Fax:773-929-6606
Practice Address - Street 1:2308 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6423
Practice Address - Country:US
Practice Address - Phone:773-755-1111
Practice Address - Fax:773-929-6606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1002510Medicaid