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General NPI Number Information
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NPI Number | 1245095348
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Entity Type | Individual
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Provider Name | KENY AMIN
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 5201 HICKORY PARK DR STE B
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City | GLEN ALLEN
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State | VA
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Zip | 23059-2623
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Country | US
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Telephone | 804-233-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 11128 SWANEE MILL TRCE
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City | GLEN ALLEN
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State | VA
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Zip | 23059-4856
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Country | US
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Telephone | 513-680-5838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401418949
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License Number State | VA
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