Provider Demographics
NPI:1285770859
Name:JIANG, KENNETH KECHENG (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:KECHENG
Last Name:JIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KECHENG
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2584
Mailing Address - Country:US
Mailing Address - Phone:513-705-4754
Mailing Address - Fax:513-420-5156
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-2584
Practice Address - Country:US
Practice Address - Phone:513-705-4754
Practice Address - Fax:513-420-5156
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2713326Medicaid
OHJI4201911Medicare PIN
OHI68385Medicare UPIN
OHH119341Medicare PIN
OHP00453808Medicare PIN