Healthcare Provider Details

I. General information

NPI: 1073318929
Provider Name (Legal Business Name): KIAN MADJEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S LOOP RD STE 200
EDGEWOOD KY
41017-3415
US

IV. Provider business mailing address

95 BURMA STAR ROAD, SW UNIT 3308
CALGARY AB
T3E 8A9
CA

V. Phone/Fax

Practice location:
  • Phone: 513-984-5133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.153212
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number35.153212
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number032417
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: