Provider Demographics
NPI:1558506725
Name:LUM, KENNETH GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GREGORY
Last Name:LUM
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 1:111 DEERWOOD RD
Mailing Address - Street 2:SUITE 368
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4409
Mailing Address - Country:US
Mailing Address - Phone:925-855-1026
Mailing Address - Fax:925-855-1027
Practice Address - Street 1:111 DEERWOOD RD
Practice Address - Street 2:SUITE 368
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4409
Practice Address - Country:US
Practice Address - Phone:925-855-1026
Practice Address - Fax:925-855-1027
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist