Provider Demographics
NPI:1235713223
Name:CHIANG, KEVIN CLEMENT (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CLEMENT
Last Name:CHIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13207 RAVENNA RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-7032
Mailing Address - Country:US
Mailing Address - Phone:440-914-7865
Mailing Address - Fax:440-914-7871
Practice Address - Street 1:13207 RAVENNA RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7032
Practice Address - Country:US
Practice Address - Phone:440-914-7865
Practice Address - Fax:440-914-7871
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.1505732080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine