Provider Demographics
NPI:1295994572
Name:JIANG, KEVIN NAN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:NAN
Last Name:JIANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:56-45 MAIN STREET, 4TH FLOOR SOUTH
Mailing Address - Street 2:NEW YORK HOSPITAL QUEENS
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:866-670-6824
Mailing Address - Fax:
Practice Address - Street 1:7206 NORTHERN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1049
Practice Address - Country:US
Practice Address - Phone:866-670-6824
Practice Address - Fax:718-533-1774
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY269139207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine