Provider Demographics
NPI:1972672889
Name:JEN KIN, PHILIP ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ROY
Last Name:JEN KIN
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 1:18822 PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9242
Mailing Address - Country:US
Mailing Address - Phone:562-920-1731
Mailing Address - Fax:562-866-2701
Practice Address - Street 1:18822 PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-9242
Practice Address - Country:US
Practice Address - Phone:562-920-1731
Practice Address - Fax:562-866-2701
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist