Healthcare Provider Details

I. General information

NPI: 1952400681
Provider Name (Legal Business Name): KENNETH KAION TSE JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 MISSION RD
SOUTH SAN FRANCISCO CA
94080-1397
US

IV. Provider business mailing address

1215 MISSION RD
SOUTH SAN FRANCISCO CA
94080-1397
US

V. Phone/Fax

Practice location:
  • Phone: 650-871-5437
  • Fax: 650-873-2662
Mailing address:
  • Phone: 650-871-5437
  • Fax: 650-873-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number45782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: