Provider Demographics
NPI:1346423357
Name:KHOO, KENNETH BOON WOON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:BOON WOON
Last Name:KHOO
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 1:26061 HINCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3945
Mailing Address - Country:US
Mailing Address - Phone:909-796-8446
Mailing Address - Fax:
Practice Address - Street 1:2606 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3207
Practice Address - Country:US
Practice Address - Phone:714-639-6181
Practice Address - Fax:714-639-6182
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice