Basic Information
Provider Information
NPI: 1750791091
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIANI
FirstName: SARAH
MiddleName: ZIA
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 850 HARVARD WAY
Address2:  
City: RENO
State: NV
PostalCode: 895022055
CountryCode: US
TelephoneNumber: 7759825262
FaxNumber: 7759825496
Practice Location
Address1: 1155 MILL ST
Address2:  
City: RENO
State: NV
PostalCode: 895021576
CountryCode: US
TelephoneNumber: 7759827878
FaxNumber: 7759824196
Other Information
ProviderEnumerationDate: 05/07/2014
LastUpdateDate: 10/19/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X17195NVY Allopathic & Osteopathic PhysiciansHospitalist 
207Q00000X17195NVN Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
1405284601 CAQHOTHER


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