Provider Demographics
NPI:1285807362
Name:LONG, KIANA (DO)
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:
Last Name:LONG
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 1:1109 SE MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3149
Mailing Address - Country:US
Mailing Address - Phone:925-354-6074
Mailing Address - Fax:
Practice Address - Street 1:191 IOWA BLVD
Practice Address - Street 2:WRIGHT MEMORIAL HOSPITAL
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-8343
Practice Address - Country:US
Practice Address - Phone:660-358-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100000750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine