Provider Demographics
NPI:1356376396
Name:KIANI, KIA (DDS)
Entity type:Individual
Prefix:DR
First Name:KIA
Middle Name:
Last Name:KIANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 GATEWAY UNIT 1531
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1592
Mailing Address - Country:US
Mailing Address - Phone:310-691-2100
Mailing Address - Fax:
Practice Address - Street 1:7725 GATEWAY UNIT 1531
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1592
Practice Address - Country:US
Practice Address - Phone:310-691-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11918122300000X
CA60832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist