MEDICARE: NAVID KIA DDSPS

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	122300000X	Dentist	019023907	IL

General Provider Information

NPI Number	:	1548535081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVID KIA DDSPS

Provider Business Mailing Address
First Line	:	3074 W IL ROUTE 60
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4270
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3074 W IL ROUTE 60
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4270
Country	:	US
Telephone Number	:	847-970-7070
Fax Number	:	847-970-7077

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAVID KIA
Credential	:
Telephone Number	:	847-970-7070

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	03/16/2012

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Directions to “NAVID KIA DDSPS ” Practice Location

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