Provider Demographics
NPI:1972327997
Name:MALEKI-YAZDI, KEON ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:KEON
Middle Name:ANDRE
Last Name:MALEKI-YAZDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3754 MILLPOND CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5310
Mailing Address - Country:US
Mailing Address - Phone:613-888-6854
Mailing Address - Fax:
Practice Address - Street 1:3754 MILLPOND CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5310
Practice Address - Country:US
Practice Address - Phone:613-888-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101284084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine