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General NPI Number Information
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NPI Number | 1215201488
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Entity Type | Organization
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Legal Business Name | CHONG KENNETH YE, DMD, INC.
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 651 S BEACH BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-5854
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Country | US
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Telephone | 562-691-3697
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Fax | 562-691-3797
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Provider Business Mailing Address
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Address Line | 651 S BEACH BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-5854
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Country | US
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Telephone | 562-691-3697
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Fax | 562-691-3797
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHONG KENNETH YE
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Credential | DMD
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Telephone | 562-691-3697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 54964
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License Number State | CA
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