Provider Demographics
NPI:1154125631
Name:CHIAN, KENNETH
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CHIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KENNY
Other - Middle Name:
Other - Last Name:CHIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1347 KINGS PARK DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4836
Mailing Address - Country:US
Mailing Address - Phone:404-644-2525
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-727-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program