MEDICARE: KENS DENTAL PARTNERSHIP

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1972136877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENS DENTAL PARTNERSHIP

Provider Business Mailing Address
First Line	:	1928 TYLER AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-3609
Country	:	US
Telephone Number	:	626-443-7922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 TYLER AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-3609
Country	:	US
Telephone Number	:	626-443-7922
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	SANJAY LALA
Credential	:
Telephone Number	:	818-508-2250

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	02/28/2020

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