Provider Demographics
NPI:1831680941
Name:POORKIYANI, KAMDIN
Entity type:Individual
Prefix:
First Name:KAMDIN
Middle Name:
Last Name:POORKIYANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6573 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-3115
Mailing Address - Country:US
Mailing Address - Phone:440-585-6400
Mailing Address - Fax:
Practice Address - Street 1:2501 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-5058
Practice Address - Country:US
Practice Address - Phone:325-692-4053
Practice Address - Fax:325-795-3037
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.030252207R00000X
TXT8018208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine