Provider Demographics
NPI:1588657837
Name:KAZ, KIAN MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIAN
Middle Name:MONICA
Last Name:KAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KIAN
Other - Middle Name:MONICA
Other - Last Name:KAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12690 MCMANUS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4433
Mailing Address - Country:US
Mailing Address - Phone:757-875-7700
Mailing Address - Fax:757-875-7721
Practice Address - Street 1:12690 MCMANUS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4433
Practice Address - Country:US
Practice Address - Phone:757-875-7700
Practice Address - Fax:757-875-7721
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058286207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA026179OtherCIGNA
VA52357OtherOPTIMA HEALTH
VA0063057570Medicaid
VA117671OtherANTHEM BCBS
VA464665OtherMAMSI
VA117671OtherANTHEM BCBS
VACO9593Medicare PIN
VA026179OtherCIGNA