=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679648737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL ARNOLD KIYAN O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 11/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1887 BUSINESS CENTER DR SUITE 2A
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-383-1053
-----------------------------------------------------
Fax | 909-381-2144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1887 BUSINESS CENTER DR SUITE 2A
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-383-1053
-----------------------------------------------------
Fax | 909-381-2144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 5891T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------