Provider Demographics
NPI:1477628642
Name:HOANG, KENNETH VU (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:VU
Last Name:HOANG
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 1:6950 SANTA TERESA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1300
Mailing Address - Country:US
Mailing Address - Phone:408-629-1212
Mailing Address - Fax:408-629-1211
Practice Address - Street 1:6950 SANTA TERESA BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1300
Practice Address - Country:US
Practice Address - Phone:408-629-1212
Practice Address - Fax:408-629-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist