MEDICARE: DR. KENNETH KAION TSE JR. DDS

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	1223P0221X	Pediatric Dentistry	45782	CA

General Provider Information

NPI Number	:	1952400681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH KAION TSE JR. DDS

Provider Business Mailing Address
First Line	:	1215 MISSION RD
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-1397
Country	:	US
Telephone Number	:	650-871-5437
Fax Number	:	650-873-2662

Provider Business Practice Location Address
First Line	:	1215 MISSION RD
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-1397
Country	:	US
Telephone Number	:	650-871-5437
Fax Number	:	650-873-2662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	10/01/2013

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