Provider Demographics
NPI:1518022599
Name:TA, KIEN T (DC)
Entity Type:Individual
Prefix:DR
First Name:KIEN
Middle Name:T
Last Name:TA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 EL CAJON BLVD, SUITE #B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105
Mailing Address - Country:US
Mailing Address - Phone:619-283-6615
Mailing Address - Fax:619-283-5772
Practice Address - Street 1:3902 EL CAJON BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1023
Practice Address - Country:US
Practice Address - Phone:619-283-6615
Practice Address - Fax:619-283-5772
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor