Provider Demographics
NPI:1700088804
Name:KIA, KEVIN FARZIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:FARZIN
Last Name:KIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 BUENA VISTA ST APT E
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4425
Mailing Address - Country:US
Mailing Address - Phone:734-945-7491
Mailing Address - Fax:
Practice Address - Street 1:1919 S SHILOH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8234
Practice Address - Country:US
Practice Address - Phone:734-945-7491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0886207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology