Provider Demographics
NPI:1033279203
Name:HAMADA, KENNETH MASAYUKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MASAYUKI
Last Name:HAMADA
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 1:1201 W ARMY TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3152
Mailing Address - Country:US
Mailing Address - Phone:630-543-8688
Mailing Address - Fax:630-543-8692
Practice Address - Street 1:1201 W ARMY TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3152
Practice Address - Country:US
Practice Address - Phone:630-543-8688
Practice Address - Fax:630-543-8692
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice