Provider Demographics
NPI:1053525188
Name:RAMESH, VIDYA KIANI (MD)
Entity type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:KIANI
Last Name:RAMESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18750 CHELTON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5204
Mailing Address - Country:US
Mailing Address - Phone:248-761-2832
Mailing Address - Fax:
Practice Address - Street 1:400 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6814
Practice Address - Country:US
Practice Address - Phone:800-780-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095861207Q00000X, 207Q00000X
CAA110935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1053525188Medicaid