Provider Demographics
NPI:1356606495
Name:KIMIAEI-ASADI, PAYAM (DMD)
Entity type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:KIMIAEI-ASADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3707
Mailing Address - Country:US
Mailing Address - Phone:520-353-3002
Mailing Address - Fax:520-293-3723
Practice Address - Street 1:5209 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3707
Practice Address - Country:US
Practice Address - Phone:520-353-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008483122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist