Provider Demographics
NPI:1689413288
Name:TEHRANI, KIMIA (PA-C)
Entity type:Individual
Prefix:
First Name:KIMIA
Middle Name:
Last Name:TEHRANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 NE 2ND AVE APT 369
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4734
Mailing Address - Country:US
Mailing Address - Phone:720-532-7221
Mailing Address - Fax:
Practice Address - Street 1:2600 E COMMERCIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4125
Practice Address - Country:US
Practice Address - Phone:954-566-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant