Provider Demographics
NPI:1265619456
Name:KITIWAN, BOONSONG KIANG (MD)
Entity type:Individual
Prefix:DR
First Name:BOONSONG
Middle Name:KIANG
Last Name:KITIWAN
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 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9466
Mailing Address - Country:US
Mailing Address - Phone:606-487-7991
Mailing Address - Fax:606-439-6685
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 1J
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9466
Practice Address - Country:US
Practice Address - Phone:606-487-7991
Practice Address - Fax:606-439-6685
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP20819207R00000X
KY44085207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine