Healthcare Provider Details

I. General information

NPI: 1861418436
Provider Name (Legal Business Name): ALI KIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD STE 230
LAS VEGAS NV
89102-2353
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-5070
  • Fax: 702-671-5198
Mailing address:
  • Phone: 702-780-7118
  • Fax: 702-671-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11940
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: