Provider Demographics
NPI:1548408784
Name:KECHICHIAN, KEVORK AGOP
Entity Type:Individual
Prefix:
First Name:KEVORK
Middle Name:AGOP
Last Name:KECHICHIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 OLD WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6624
Mailing Address - Country:US
Mailing Address - Phone:401-723-4336
Mailing Address - Fax:401-723-4336
Practice Address - Street 1:110 ARMISTICE BLVD
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5354
Practice Address - Country:US
Practice Address - Phone:401-723-4336
Practice Address - Fax:401-723-4336
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDAOM00032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist