Provider Demographics
NPI:1609093400
Name:HO, KENNETH CHIANG (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHIANG
Last Name:HO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3567
Mailing Address - Country:US
Mailing Address - Phone:818-790-3923
Mailing Address - Fax:818-790-1364
Practice Address - Street 1:400 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3567
Practice Address - Country:US
Practice Address - Phone:818-790-3923
Practice Address - Fax:818-790-1364
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist