Provider Demographics
NPI:1871778290
Name:KENNETH G. CHEN D.D.S. INC.
Entity type:Organization
Organization Name:KENNETH G. CHEN D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-744-2168
Mailing Address - Street 1:1001 W SAN MARCOS BLVD
Mailing Address - Street 2:STE. 106C
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4012
Mailing Address - Country:US
Mailing Address - Phone:760-744-2168
Mailing Address - Fax:760-744-0909
Practice Address - Street 1:1001 W SAN MARCOS BLVD
Practice Address - Street 2:STE. 106C
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4012
Practice Address - Country:US
Practice Address - Phone:760-744-2168
Practice Address - Fax:760-744-0909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNETH G. CHEN D.D.S. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty