Provider Demographics
NPI:1033252481
Name:SANTIAGO, KENNETH (HS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19746 TWIN CANYON CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8812
Mailing Address - Country:US
Mailing Address - Phone:832-746-5416
Mailing Address - Fax:
Practice Address - Street 1:701 SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-3673
Practice Address - Country:US
Practice Address - Phone:713-718-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other