MEDICARE: DR. SEAN T KY DDS

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	1223G0001X	General Practice Dentistry	45481	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1323676	OTHER	CA	UNITED CONCORDIA INS
2	B45481	OTHER	CA	HEALTHY FAMILIES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821052861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN T KY DDS

Provider Business Mailing Address
First Line	:	3858 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3940
Country	:	US
Telephone Number	:	626-795-4251
Fax Number	:	626-795-3562

Provider Business Practice Location Address
First Line	:	3858 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3940
Country	:	US
Telephone Number	:	626-795-4251
Fax Number	:	626-795-3562

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	10/01/2012

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