Provider Demographics
NPI:1942241740
Name:KIAI, KIANUSCH (MD)
Entity Type:Individual
Prefix:
First Name:KIANUSCH
Middle Name:
Last Name:KIAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3445 PACIFIC COAST HWY STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6660
Practice Address - Country:US
Practice Address - Phone:310-530-8001
Practice Address - Fax:310-530-8012
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55126207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A551260OtherBLUE SHIELD OF CA
CA00A551260Medicaid
CA00A551260303OtherCALOPTIMA
CA00A551260OtherBLUE SHIELD OF CA
CAWA55126AMedicare ID - Type Unspecified