Provider Demographics
NPI:1649005174
Name:KIAN, LAURA PATRICIA (LIC ELECTROLOGIST)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PATRICIA
Last Name:KIAN
Suffix:
Gender:F
Credentials:LIC ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SIERRA GARDENS DR STE 8
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2912
Mailing Address - Country:US
Mailing Address - Phone:916-996-3435
Mailing Address - Fax:
Practice Address - Street 1:1850 SIERRA GARDENS DR STE 8
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2912
Practice Address - Country:US
Practice Address - Phone:916-996-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist