MEDICARE: KIANUSCH KIAI 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1932038510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIANUSCH KIAI INC

Provider Business Mailing Address
First Line	:	PO BOX 7001
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91357-7001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4553 GLENCOE AVE STE 100
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-7917
Country	:	US
Telephone Number	:	310-912-6170
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIANUSCH KIAI
Credential	:	MD
Telephone Number	:	310-351-5191

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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