Provider Demographics
NPI:1346485075
Name:KENAN & WANG LLC
Entity Type:Organization
Organization Name:KENAN & WANG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-580-5249
Mailing Address - Street 1:9522 BULLION WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-5427
Mailing Address - Country:US
Mailing Address - Phone:916-580-5249
Mailing Address - Fax:916-990-0668
Practice Address - Street 1:331 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2211
Practice Address - Country:US
Practice Address - Phone:916-553-0028
Practice Address - Fax:916-553-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99168261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care