Provider Demographics
NPI:1437688991
Name:KIAN, MARIA CLORIS (ELECTROLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CLORIS
Last Name:KIAN
Suffix:
Gender:F
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3847 DOTTY ST
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2714
Mailing Address - Country:US
Mailing Address - Phone:916-996-3435
Mailing Address - Fax:
Practice Address - Street 1:106N SUNRISE AVE, B-8, ROOMS #1-2
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-996-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL2616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist