Provider Demographics
NPI:1023279239
Name:KIAI, AZITA (DC)
Entity type:Individual
Prefix:DR
First Name:AZITA
Middle Name:
Last Name:KIAI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 W IMPERIAL HWY
Mailing Address - Street 2:SUITE #316
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-3143
Mailing Address - Country:US
Mailing Address - Phone:323-242-2222
Mailing Address - Fax:323-242-2440
Practice Address - Street 1:2930 W IMPERIAL HWY
Practice Address - Street 2:SUITE #316
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3143
Practice Address - Country:US
Practice Address - Phone:323-242-2222
Practice Address - Fax:323-242-2440
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor