Provider Demographics
NPI:1932192721
Name:KARDAN, AZAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AZAR
Middle Name:
Last Name:KARDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 SHROYER RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-4055
Mailing Address - Country:US
Mailing Address - Phone:937-296-1126
Mailing Address - Fax:937-296-1728
Practice Address - Street 1:617 SHROYER RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4055
Practice Address - Country:US
Practice Address - Phone:937-296-1126
Practice Address - Fax:937-296-1728
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043779208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0706347Medicaid
OH0706347Medicaid