Provider Demographics
NPI:1053744177
Name:CHIANG, KEVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:CHIANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:D
Other - Last Name:CHIANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2265 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6503
Mailing Address - Country:US
Mailing Address - Phone:310-564-6231
Mailing Address - Fax:
Practice Address - Street 1:637 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4621
Practice Address - Country:US
Practice Address - Phone:310-564-6231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics