MEDICARE: KENNY KIEU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant

General Provider Information

NPI Number	:	1851002075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY KIEU

Provider Business Mailing Address
First Line	:	10412 AMY WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10412 AMY WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6918
Country	:	US
Telephone Number	:	405-209-6225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	12/08/2022

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Directions to “ KENNY KIEU ” Practice Location

Language	Start Address	Practice Location

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