Provider Demographics
NPI:1396008389
Name:KIANMAJD, MAJID (DO)
Entity Type:Individual
Prefix:
First Name:MAJID
Middle Name:
Last Name:KIANMAJD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PENNSYLVANIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3550
Mailing Address - Country:US
Mailing Address - Phone:707-646-4180
Mailing Address - Fax:
Practice Address - Street 1:1860 PENNSYLVANIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3550
Practice Address - Country:US
Practice Address - Phone:707-646-4180
Practice Address - Fax:707-646-4185
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10090300208600000X
TXR4575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388182301Medicaid