Provider Demographics
NPI:1063947729
Name:KIYDAL, DANYA M (MD)
Entity type:Individual
Prefix:
First Name:DANYA
Middle Name:M
Last Name:KIYDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANYA
Other - Middle Name:
Other - Last Name:LOUTFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4501 ACORN LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7798
Mailing Address - Country:US
Mailing Address - Phone:352-653-8683
Mailing Address - Fax:
Practice Address - Street 1:210 9TH ST SE STE 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6400
Practice Address - Country:US
Practice Address - Phone:507-292-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086744A208D00000X
390200000X
MN769122083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program