Organization Name: | KENNETH K. CHAN, DDS, A PROFESSIONAL CORPORATION |
NPI Number: | 1043406853 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNETH KA CHAN (DENTIST) |
Mailing Address: | 1315 Fair Oaks Ave Suite 103 South Pasadena |
State: | CA US |
Postal Code: | 910303868 |
Phone Number: | 6267998068 |
Fax Number: | 6267998069 |
NPI Enumeration Date: | 09/15/2007 |
NPI Last Update Date: | 09/15/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |