Provider Demographics
NPI:1336222405
Name:KIEV, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KIEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1406 W 5TH ST STE 301
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1688
Practice Address - Country:US
Practice Address - Phone:606-330-2370
Practice Address - Fax:606-877-1593
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24757208600000X, 208G00000X
VA0101235335208600000X, 208G00000X
KY50542208600000X, 208G00000X
MDD0066881208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCK6410003OtherBCBS
MD7803509OtherAETNA PPO
VA010022908Medicaid
MD1755423OtherAETNA HMO
KY7100196590Medicaid
MD92465501OtherBCBS
MD414044300Medicaid
P00653228Medicare PIN
MD92465501OtherBCBS
MD7803509OtherAETNA PPO
MDF89898Medicare UPIN