Healthcare Provider Details

I. General information

NPI: 1164513131
Provider Name (Legal Business Name): KENNETH KAI DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MONTCLAIR AVENUE #A
SAN JOSE CA
95116
US

IV. Provider business mailing address

250 MONTCLAIR AVE #A
SAN JOSE CA
95116
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-7141
  • Fax:
Mailing address:
  • Phone: 408-258-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: