Provider Demographics
NPI:1518004191
Name:TSANG, KENNETH J (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:TSANG
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 1:623 N MONTEREY ST
Mailing Address - Street 2:#12A
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1593
Mailing Address - Country:US
Mailing Address - Phone:626-282-8035
Mailing Address - Fax:
Practice Address - Street 1:510 W AVENUE P
Practice Address - Street 2:ORTHODONTICS DEPT
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3737
Practice Address - Country:US
Practice Address - Phone:661-281-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics