Provider Demographics
NPI:1699954107
Name:RAMEZANI, KIA (DDS)
Entity type:Individual
Prefix:DR
First Name:KIA
Middle Name:
Last Name:RAMEZANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COTTONWOOD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1657
Mailing Address - Country:US
Mailing Address - Phone:714-833-9070
Mailing Address - Fax:949-461-0030
Practice Address - Street 1:6 COTTONWOOD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92657-1657
Practice Address - Country:US
Practice Address - Phone:714-833-9070
Practice Address - Fax:949-461-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD56380Medicaid