Healthcare Provider Details

I. General information

NPI: 1396008389
Provider Name (Legal Business Name): MAJID KIANMAJD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 PENNSYLVANIA AVE STE 200
FAIRFIELD CA
94533-3550
US

IV. Provider business mailing address

1860 PENNSYLVANIA AVE STE 200
FAIRFIELD CA
94533-3550
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-4180
  • Fax: 707-646-4185
Mailing address:
  • Phone: 707-646-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB10090300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR4575
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: