Provider Demographics
NPI:1831299254
Name:KIAFAR, CAMRON (DO)
Entity Type:Individual
Prefix:
First Name:CAMRON
Middle Name:
Last Name:KIAFAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SAN BERNARDINO RD STE 103
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4985
Mailing Address - Country:US
Mailing Address - Phone:909-920-0444
Mailing Address - Fax:909-920-5044
Practice Address - Street 1:1310 SAN BERNARDINO RD STE 103
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4985
Practice Address - Country:US
Practice Address - Phone:909-920-0444
Practice Address - Fax:909-920-5044
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3602207RG0100X
CA2OA7773207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH30365Medicare UPIN