MEDICARE: CHONG KENNETH YE, DMD, INC.

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	122300000X	Dentist	54964	CA

General Provider Information

NPI Number	:	1215201488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHONG KENNETH YE, DMD, INC.

Provider Business Mailing Address
First Line	:	651 S BEACH BLVD
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-5854
Country	:	US
Telephone Number	:	562-691-3697
Fax Number	:	562-691-3797

Provider Business Practice Location Address
First Line	:	651 S BEACH BLVD
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-5854
Country	:	US
Telephone Number	:	562-691-3697
Fax Number	:	562-691-3797

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHONG KENNETH YE
Credential	:	DMD
Telephone Number	:	562-691-3697

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	03/05/2012

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