Provider Demographics
NPI:1194953190
Name:KIANI AZARBAYJANI, ABRAHAM MAZDA (MD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:MAZDA
Last Name:KIANI AZARBAYJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABRAHAM
Other - Middle Name:MAZDA
Other - Last Name:KIANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:949-679-6100
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:949-394-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99386207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology