Healthcare Provider Details

I. General information

NPI: 1932697190
Provider Name (Legal Business Name): KIAN AHMADIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 E WARNER RD BLDG 5
GILBERT AZ
85296-3054
US

IV. Provider business mailing address

PO BOX 60691
CITY OF INDUSTRY CA
91716-0691
US

V. Phone/Fax

Practice location:
  • Phone: 480-664-0261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number59591
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number59591
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: