Organization
ADVANCED LASER & SURGICENTER OF ARIZONA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIANOUSH KIAN MD (ADMINISTRATOR)
(480) 632-2020
Entity
Organization
Contact information
Practice address
3303 E BASELINE RD, #104, GILBERT, AZ 85234-2739
(480) 632-2020
(480) 632-2121
Mailing address
3303 E BASELINE RD, #104, GILBERT, AZ 85234-2739
(480) 632-2020
(480) 632-2121
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC3540
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
907610
AZ HEALTH CARE COST SYS
AZ
01
—
AZ0209500
BCBS OF AZ
—
01
—
IZ0620
HEALTH NET INS
AZ
Enumeration date
05/19/2006
Last updated
05/08/2013
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