Provider Demographics
NPI:1679648737
Name:KIYAN, PAUL ARNOLD (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ARNOLD
Last Name:KIYAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3463
Mailing Address - Country:US
Mailing Address - Phone:909-383-1053
Mailing Address - Fax:909-381-2144
Practice Address - Street 1:1887 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3463
Practice Address - Country:US
Practice Address - Phone:909-383-1053
Practice Address - Fax:909-381-2144
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5891T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058911Medicare PIN
CA0234600001Medicare NSC