Provider Demographics
NPI:1487378246
Name:JIANG, KEVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:JIANG
Suffix:
Gender:M
Credentials:DMD
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 2682
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-0682
Mailing Address - Country:US
Mailing Address - Phone:510-688-0356
Mailing Address - Fax:
Practice Address - Street 1:1870 LUNDY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1826
Practice Address - Country:US
Practice Address - Phone:408-573-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist