Provider Demographics
NPI:1912023318
Name:HAJEK, KENNETH F (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:HAJEK
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 1:2774 MINERS FLAT RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95634
Mailing Address - Country:US
Mailing Address - Phone:530-333-4114
Mailing Address - Fax:
Practice Address - Street 1:2774 MINERS FLAT RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:CA
Practice Address - Zip Code:95634
Practice Address - Country:US
Practice Address - Phone:530-333-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD26761Medicaid