Provider Demographics
NPI:1205279791
Name:KAISER, IAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:DAVID
Last Name:KAISER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3660 PARK SIERRA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3071
Mailing Address - Country:US
Mailing Address - Phone:951-687-3400
Mailing Address - Fax:951-687-7630
Practice Address - Street 1:46883 MONROE ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6769
Practice Address - Country:US
Practice Address - Phone:760-254-8960
Practice Address - Fax:760-208-1802
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2024-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2020027065207RN0300X
CA191771207RN0300X
NY295609207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205279791Medicaid
NY05757933Medicaid