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General NPI Number Information
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NPI Number | 1891256624
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Entity Type | Individual
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Provider Name | KIA PERSAUD MBBS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 2021 N MYRTLE POINT BLVD STE 102
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2224
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Country | US
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Telephone | 843-366-3060
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Fax | 843-366-3069
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Provider Business Mailing Address
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Address Line | 2021 N MYRTLE POINT BLVD STE 102
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2224
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Country | US
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Telephone | 843-366-3060
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Fax | 843-366-3069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 93036
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License Number State | SC
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