Provider Demographics
NPI:1598541724
Name:ABEDINZADEH, KIMIYA
Entity Type:Individual
Prefix:DR
First Name:KIMIYA
Middle Name:
Last Name:ABEDINZADEH
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 1:20701 ASHBURN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4660
Mailing Address - Country:US
Mailing Address - Phone:703-629-6638
Mailing Address - Fax:
Practice Address - Street 1:101 CROSSTRAIL BLVD SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4660
Practice Address - Country:US
Practice Address - Phone:703-669-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist