| Organization Name: | KS HOLDINGS PA |
| NPI Number: | 1013328608 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KYLE JOHN SKJEI (DENTIST) |
| Mailing Address: | 751 Rose Dr Nw Suite 108 Big Lake |
| State: | MN US |
| Postal Code: | 553098705 |
| Phone Number: | 7632620259 |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2014 |
| NPI Last Update Date: | 05/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 12781 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |