Provider Demographics
NPI:1871151563
Name:KANI, SABA HAJIMOLLAALI (DPM)
Entity type:Individual
Prefix:
First Name:SABA
Middle Name:HAJIMOLLAALI
Last Name:KANI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 CLEARWATER DR STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7165
Mailing Address - Country:US
Mailing Address - Phone:928-216-3366
Mailing Address - Fax:
Practice Address - Street 1:3103 CLEARWATER DR STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7165
Practice Address - Country:US
Practice Address - Phone:928-216-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-001047213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH107031720-00Medicaid