Provider Demographics
NPI:1154328615
Name:KIMYAI-ASADI, TAGHI (MD)
Entity Type:Individual
Prefix:DR
First Name:TAGHI
Middle Name:
Last Name:KIMYAI-ASADI
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:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1400
Mailing Address - Country:US
Mailing Address - Phone:703-383-9543
Mailing Address - Fax:703-383-9532
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-561-8464
Practice Address - Fax:202-563-3861
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD169472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025111800Medicaid
E13408Medicare UPIN
DC025111800Medicaid