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General NPI Number Information
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NPI Number | 1548408784
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Entity Type | Individual
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Provider Name | KEVORK AGOP KECHICHIAN
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Gender | Male
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 110 ARMISTICE BLVD
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City | PAWTUCKET
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State | RI
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Zip | 02860-5354
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Country | US
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Telephone | 401-723-4336
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Fax | 401-723-4336
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Provider Business Mailing Address
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Address Line | 59 OLD WILLIS RD
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City | CUMBERLAND
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State | RI
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Zip | 02864-6624
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Country | US
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Telephone | 401-723-4336
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Fax | 401-723-4336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | DAOM00032
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License Number State | RI
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