Provider Demographics
NPI:1417182924
Name:HU, KENPAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENPAN
Middle Name:
Last Name:HU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 SAN DARIO AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78401
Mailing Address - Country:US
Mailing Address - Phone:617-319-7110
Mailing Address - Fax:
Practice Address - Street 1:4817 SAN DARIO AVENUE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78401
Practice Address - Country:US
Practice Address - Phone:956-728-7412
Practice Address - Fax:956-728-7682
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551191223G0001X
TX274391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice