Provider Demographics
NPI:1265551501
Name:KADIANAKIS, KIKI (DO)
Entity type:Individual
Prefix:DR
First Name:KIKI
Middle Name:
Last Name:KADIANAKIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1875
Mailing Address - Country:US
Mailing Address - Phone:718-423-0808
Mailing Address - Fax:718-204-6866
Practice Address - Street 1:4604 31ST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11103-1842
Practice Address - Country:US
Practice Address - Phone:718-545-2100
Practice Address - Fax:718-545-1900
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02985546Medicaid
NY01HCSDMedicare PIN
NYG67502Medicare UPIN