Provider Demographics
NPI:1275969867
Name:AMIN, KIRAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1575
Mailing Address - Country:US
Mailing Address - Phone:602-678-5768
Mailing Address - Fax:602-466-7500
Practice Address - Street 1:720 E PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1575
Practice Address - Country:US
Practice Address - Phone:602-678-5768
Practice Address - Fax:602-466-7500
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1578103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist