Provider Demographics
NPI:1497863765
Name:KIEU, KEVIN NAM (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:NAM
Last Name:KIEU
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 WARNER AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1619
Mailing Address - Country:US
Mailing Address - Phone:714-965-9553
Mailing Address - Fax:714-965-9555
Practice Address - Street 1:10130 WARNER AVE
Practice Address - Street 2:SUITE I
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1619
Practice Address - Country:US
Practice Address - Phone:714-965-9553
Practice Address - Fax:714-965-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics