Provider Demographics
NPI:1073318929
Name:MADJEDI, KIAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIAN
Middle Name:
Last Name:MADJEDI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BURMA STAR ROAD, SW
Mailing Address - Street 2:UNIT 3308
Mailing Address - City:CALGARY
Mailing Address - State:AB
Mailing Address - Zip Code:T3E 8A9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 S LOOP RD STE 200
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3415
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ032417207WX0120X
OH35.153212207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist