Healthcare Provider Details

I. General information

NPI: 1275321655
Provider Name (Legal Business Name): KIAN MEMARI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1898
US

IV. Provider business mailing address

3300 W ROLLING HILLS CIR APT 709
DAVIE FL
33328-1977
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO10423
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUO10423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: