Healthcare Provider Details

I. General information

NPI: 1417950205
Provider Name (Legal Business Name): VIC KADYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CURTIS RD STE 202
BOISE ID
83706
US

IV. Provider business mailing address

1000 N CURTIS RD STE 202
BOISE ID
83706-1346
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-3435
  • Fax: 208-377-3147
Mailing address:
  • Phone: 208-377-3435
  • Fax: 208-377-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberM9112
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM9112
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: