Provider Demographics
NPI:1407002231
Name:CHENEWETH, KAIYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAIYAN
Middle Name:
Last Name:CHENEWETH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12396 WORLD TRADE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3788
Mailing Address - Country:US
Mailing Address - Phone:858-451-2104
Mailing Address - Fax:
Practice Address - Street 1:12396 WORLD TRADE DR STE 209
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3788
Practice Address - Country:US
Practice Address - Phone:858-451-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice