Healthcare Provider Details

I. General information

NPI: 1326842089
Provider Name (Legal Business Name): AHMAD KIWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708-2600
US

IV. Provider business mailing address

400 BLAKE ST APT 1212
NEW HAVEN CT
06515-4428
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6000
  • Fax:
Mailing address:
  • Phone: 646-912-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: