Provider Demographics
NPI:1467504480
Name:YASUDA, KENNETH T (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:T
Last Name:YASUDA
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 1:650 HOWE AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4731
Mailing Address - Country:US
Mailing Address - Phone:916-929-8928
Mailing Address - Fax:916-920-3712
Practice Address - Street 1:650 HOWE AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4731
Practice Address - Country:US
Practice Address - Phone:916-929-8928
Practice Address - Fax:916-920-3712
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice