Provider Demographics
NPI:1619350527
Name:KIANI, VIVIAN
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:KIANI
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 1:27001 LA PAZ RD STE 448B
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5526
Mailing Address - Country:US
Mailing Address - Phone:949-413-7259
Mailing Address - Fax:
Practice Address - Street 1:27001 LA PAZ RD STE 448B
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5526
Practice Address - Country:US
Practice Address - Phone:949-735-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1108611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical