Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401416051 | VA |
NPI | 1043731086 |
---|---|
Provider Name | Kian Zabi Momeni |
First Address | Washington, DC 20059-1022 |
Second Address | Woodbridge, VA 22192-2335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2017 |
Last Update Date | 27/05/2020 |