Provider Demographics
NPI:1700477874
Name:VELEZ MELENDEZ, KID KHAYAM SR (MD)
Entity type:Individual
Prefix:DR
First Name:KID
Middle Name:KHAYAM
Last Name:VELEZ MELENDEZ
Suffix:SR
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:HC 3 BOX 12745
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-9637
Mailing Address - Country:US
Mailing Address - Phone:787-506-1276
Mailing Address - Fax:
Practice Address - Street 1:CHALETS DE LA FUENTE
Practice Address - Street 2:8 CALLE FLORIDIANO APT 802
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-506-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22155208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice