Provider Demographics
NPI:1972791655
Name:JOSEPH LEO KIENER MD CHTD
Entity Type:Organization
Organization Name:JOSEPH LEO KIENER MD CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAY
Authorized Official - Middle Name:LENE
Authorized Official - Last Name:HYBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-825-1234
Mailing Address - Street 1:530 HAMMILL LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2045
Mailing Address - Country:US
Mailing Address - Phone:775-825-1234
Mailing Address - Fax:775-825-2633
Practice Address - Street 1:530 HAMMILL LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2045
Practice Address - Country:US
Practice Address - Phone:775-825-1234
Practice Address - Fax:775-825-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6269208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016427Medicaid
NVMD2629Medicare PIN