Basic Information
| Provider Information | |||||||||
| NPI: | 1396008389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIANMAJD | ||||||||
| FirstName: | MAJID | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 PENNSYLVANIA AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945333550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076464180 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1860 PENNSYLVANIA AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945333550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076464180 | ||||||||
| FaxNumber: | 7076464185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2012 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MB10090300 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | R4575 | TX | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 388182301 | 05 | TX | MEDICAID |