Provider Demographics
NPI:1770651051
Name:KIWAN, SALEEM M (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:SALEEM
Middle Name:M
Last Name:KIWAN
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 2396
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93613-2396
Mailing Address - Country:US
Mailing Address - Phone:559-224-3110
Mailing Address - Fax:559-227-7752
Practice Address - Street 1:4820 N. 1ST. STREET.
Practice Address - Street 2:STE.#105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0522
Practice Address - Country:US
Practice Address - Phone:559-224-3110
Practice Address - Fax:559-227-7752
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504111223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice