Healthcare Provider Details

I. General information

NPI: 1396155297
Provider Name (Legal Business Name): JOHN KAMRAN NIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S COWLEY ST STE 201
SPOKANE WA
99202-1332
US

IV. Provider business mailing address

10 W END AVE APT 6J
NEW YORK NY
10023-7828
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-1299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD61086676
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number280740
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number280740
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD61086676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: