Provider Demographics
NPI:1902053663
Name:KIA, FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:FARID
Middle Name:
Last Name:KIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FARID
Other - Middle Name:
Other - Last Name:FARZANEHKIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 TOWN CTR W # 274
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-5075
Mailing Address - Country:US
Mailing Address - Phone:805-345-2334
Mailing Address - Fax:805-782-8097
Practice Address - Street 1:1100 PASEO CAMARILLO
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6073
Practice Address - Country:US
Practice Address - Phone:805-585-5201
Practice Address - Fax:805-782-8097
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1251192081P2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program