Provider Demographics
NPI:1477357424
Name:WANG, KEVIN ETHAN (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ETHAN
Last Name:WANG
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11986 CRANSTON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4620
Mailing Address - Country:US
Mailing Address - Phone:901-262-2976
Mailing Address - Fax:
Practice Address - Street 1:WELLSTAR KENNESTONE HOSPITAL
Practice Address - Street 2:677 CHURCH STREET NORTHEAST
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:770-793-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program