Provider Demographics
NPI:1396823092
Name:LIEN, KENNETH W (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:LIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 LAKE CHABOT RD STE 304
Mailing Address - Street 2:STE. 304
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5316
Mailing Address - Country:US
Mailing Address - Phone:510-537-0700
Mailing Address - Fax:510-537-7795
Practice Address - Street 1:20400 LAKE CHABOT RD
Practice Address - Street 2:STE. 304
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5316
Practice Address - Country:US
Practice Address - Phone:510-537-0700
Practice Address - Fax:510-537-7795
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72098207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA110780OtherGRP PTAN FOR ALLERGY, ASTHMA & SINUS CENTERS OF SILICON VALLEY
CA1396823092Medicaid
CAEK627ZOtherINDIVIDUAL MEDICARE PTAN