Provider Demographics
NPI:1376890871
Name:REZAZADEH TEHRANI, KIMIA
Entity Type:Individual
Prefix:
First Name:KIMIA
Middle Name:
Last Name:REZAZADEH TEHRANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WALLACE AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2888
Mailing Address - Country:US
Mailing Address - Phone:925-286-8833
Mailing Address - Fax:
Practice Address - Street 1:292 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6307
Practice Address - Country:US
Practice Address - Phone:718-352-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist