Provider Demographics
NPI:1346437753
Name:TJON, KENNETH ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ANDREW
Last Name:TJON
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 1:27221 LA PAZ RD STE G
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3630
Mailing Address - Country:US
Mailing Address - Phone:949-831-1402
Mailing Address - Fax:949-831-1872
Practice Address - Street 1:27221 LA PAZ RD STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3630
Practice Address - Country:US
Practice Address - Phone:949-831-1402
Practice Address - Fax:949-831-1872
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice