DR. KENNETH K TIEU (NPI# 1902122781) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902122781 |
| Entity Type | Individual |
| Full Name | DR. KENNETH K TIEU |
| Credential | M.D. |
| Practice Address |
8725 N Wickham Rd Ste 200 Melbourne FL 32940-2240 |
| Mailing Address |
3300 S Fiske Blvd Rockledge FL 32955-4306 |
| Practice Telephone | 3214349230 |
| Practice Fax Number | 3214349269 |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2020-11-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | ME114362 | FL | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | A116780 | CA | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | N6718 | TX | Allopathic & Osteopathic Physicians |
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | ME114362 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | FL MEDICARE | GQ944Y | 01 |
| FL | 008039600 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1223 Gateway Dr Ste 2b, Melbourne, FL 329012607 | 3217254500 | 3214349269 |
| 1421 Malabar Rd Ne Ste 220, Palm Bay, FL 329072559 | 3214349230 | 3214349234 |
| 1810 Eldron Blvd Se, Palm Bay, FL 329096831 | 3214349230 | 3214349269 |
| 730 Malabar Rd Ste B, Malabar, FL 329503140 | 3214349230 | 3214349269 |
| Street Address |
8725 N WICKHAM RD STE 200 |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32940-2240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700870847 | Mark Douglas Hughes | Internal Medicine | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2005-09-06 |
| 1902364292 | Dianne Sawers-vidal | Nurse Practitioner | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2019-03-06 |
| 1427409457 | Kristin E Dammann | Physician Assistant | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2016-06-30 |
| 1538418678 | Laura Grace Haver | Physician Assistant | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2012-09-05 |
| 1508179755 | Evelyn Frances Ogle | Physician Assistant | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2010-07-16 |
| 1093941205 | Xiaosong Song | Internal Medicine | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2009-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403649 | True Motion Physical Therapy and Wellness | Clinic/Center | 3536 Peninsula Circle, Mlebourne, FL 32940 | 2020-06-26 |
| 1568089431 | Live Gracefully Physio and Wellness, Pllc | Clinic/Center | 6470 Shadow Creek Trail, Apt 5204, Melbourne, FL 32940 | 2020-06-26 |
| 1295360592 | Hiteshi Patel | Pharmacist | 3134 Hummingbird Way, Melbourne, FL 32940 | 2020-03-06 |
| 1972133122 | Curtis Lynn Curbo | Social Worker | 3830 Fringetree Lane, Melbourne, FL 32940 | 2020-01-16 |
| 1861038283 | Medfast Urgent Care Centers, LLC | Clinic/Center | 5500 Stadium Parkway, Melbourne, FL 32940 | 2019-11-20 |
| 1134601594 | Caroline Grace Bennett | Behavior Technician | 5500 Murrell Rd Suite 100, Melbourne, FL 32940 | 2018-09-02 |
| 1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
| 1356849251 | Executive Non-emergency Transportation, Inc. | Non-emergency Medical Transport (VAN) | 3155-02 Suntree Blvd, Melbourne, FL 32940 | 2018-01-25 |
| 1679081160 | Brevard Oaks Center, LLC | Skilled Nursing Facility | 2355 Vidina Drive, Viera, FL 32940 | 2018-01-18 |
| 1275045817 | Comfortable Care Dental Health Professionals. P.a. | Dentist | 6340 N Wickham Rd Ste 101, Melbourne, FL 32940 | 2017-11-03 |
| Find all providers in zip 32940 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952922270 | Glenn Edmund Bryan Jr. | Surgery | 4255 N Us Highway 1, Melbourne, FL 32935-4822 | 2020-04-27 |
| 1760622526 | Space Coast Surgery LLC | Surgery | 8255 N Wickham Rd, Suite 102, Melbourne, FL 32940-8202 | 2009-03-05 |
| 1215901848 | Emran Riaz Imami | Surgery | 1140 Broadband Dr, Melbourne, FL 32901-2623 | 2006-02-13 |
| 1720062516 | Aleksander Richard Komar | Surgery | 7000 Spyglass Ct Ste 350, Melbourne, FL 32940 | 2005-12-05 |
| 1174526958 | Mark Edmund Pessa | Surgery | 1350 S Hickory St, Suite Pso, Melbourne, FL 32901 | 2005-05-24 |
| 1275033284 | Talbert General Surgery LLC | Surgery | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901-3006 | 2018-02-16 |
| 1821478512 | Surgical Robotics Md, P.a. | Surgery | 109 Silver Palm Ave, Melbourne, FL 32901-3125 | 2015-06-08 |
| 1629413042 | Mohamad Hammoud | Surgery | 1223 Gateway Dr Ste 2b, Melbourne, FL 32901-2607 | 2013-04-30 |
| 1235457458 | Akram Mouied Alashari | Surgery | 1350 Hickory St, Melbourne, FL 32901-3224 | 2010-05-12 |
| 1003132887 | Nathan D Allison | Surgery | 8725 N Wickham Rd, Suite 302, Melbourne, FL 32940-2239 | 2010-04-19 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.