MEDICARE: ALI KIA MD INC

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	207R00000X	Internal Medicine Physician	11940	NV

General Provider Information

NPI Number	:	1073777413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALI KIA MD INC

Provider Business Mailing Address
First Line	:	2540 S MARYLAND PKWY
Second Line	:	#196
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1627
Country	:	US
Telephone Number	:	909-648-2383
Fax Number	:	702-478-7263

Provider Business Practice Location Address
First Line	:	2470 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5200
Country	:	US
Telephone Number	:	702-737-1427
Fax Number	:	702-478-7263

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALI KIA
Credential	:	MD
Telephone Number	:	909-648-2383

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	09/26/2008

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Directions to “ALI KIA MD INC ” Practice Location

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