MEDICARE: DR. VIDYA KIANI RAMESH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301095861	MI
2	207Q00000X	Family Medicine Physician	A110935	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053525188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIDYA KIANI RAMESH M.D.

Provider Business Mailing Address
First Line	:	18750 CHELTON DR
Second Line	:
City	:	BEVERLY HILLS
State	:	MI
Zip	:	48025-5204
Country	:	US
Telephone Number	:	248-761-2832
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S SEPULVEDA BLVD
Second Line	:	SUITE 100
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6814
Country	:	US
Telephone Number	:	800-780-1230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	11/29/2021

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