Healthcare Provider Details

I. General information

NPI: 1649690769
Provider Name (Legal Business Name): KIYAN RAD D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5983 E GRANT RD STE 101
TUCSON AZ
85712-2366
US

IV. Provider business mailing address

PO BOX 89520
TUCSON AZ
85752-9520
US

V. Phone/Fax

Practice location:
  • Phone: 520-420-1966
  • Fax: 866-733-1907
Mailing address:
  • Phone: 520-420-1966
  • Fax: 866-733-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number1649690769
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1649690769
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number008152
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number8152
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: