Provider Demographics
NPI:1902183080
Name:DIAS, KITHSEN KALYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KITHSEN
Middle Name:KALYAN
Last Name:DIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:P.KITHSEN
Other - Middle Name:KALYAN
Other - Last Name:DIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:50 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2216
Mailing Address - Country:US
Mailing Address - Phone:516-621-5563
Mailing Address - Fax:516-621-0406
Practice Address - Street 1:50 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2216
Practice Address - Country:US
Practice Address - Phone:516-621-5563
Practice Address - Fax:516-621-0406
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1277472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry