Healthcare Provider Details

I. General information

NPI: 1255137030
Provider Name (Legal Business Name): DR. KIWIMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 CAIN CIR STE 120
DACULA GA
30019-1658
US

IV. Provider business mailing address

3640 MUNDY MILL RD. STE 112 #129
GAINESVILLE GA
30504-8201
US

V. Phone/Fax

Practice location:
  • Phone: 877-549-4633
  • Fax: 678-968-7739
Mailing address:
  • Phone: 877-549-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA ANGEL
Title or Position: OWNER
Credential: MD
Phone: 678-936-6167