Healthcare Provider Details

I. General information

NPI: 1760514343
Provider Name (Legal Business Name): KIANSI BONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HOBSON WAY # 209
OXNARD CA
93030-6706
US

IV. Provider business mailing address

PO BOX 6299
TORRANCE CA
90504-0299
US

V. Phone/Fax

Practice location:
  • Phone: 805-486-9100
  • Fax: 805-486-7444
Mailing address:
  • Phone: 805-486-9100
  • Fax: 805-486-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA45536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA45536
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA45536
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA45536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: