Provider Demographics
NPI:1689763427
Name:PARTOVI, KIANDOKHT (MD)
Entity Type:Individual
Prefix:DR
First Name:KIANDOKHT
Middle Name:
Last Name:PARTOVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 E HUNTINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702
Mailing Address - Country:US
Mailing Address - Phone:559-691-9730
Mailing Address - Fax:
Practice Address - Street 1:5153 HOLT BLVD STE B1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4837
Practice Address - Country:US
Practice Address - Phone:559-691-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06700074Medicaid
MS1689763427OtherBLUE CROSS
MS110001823Medicare ID - Type Unspecified
MS06700074Medicaid
MS1689763427OtherBLUE CROSS
MS512I110202Medicare PIN