Provider Demographics
NPI:1255343414
Name:TSE, KELVIN A (DDS)
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:A
Last Name:TSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7916 PEBBLE BEACH DR
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7790
Mailing Address - Country:US
Mailing Address - Phone:916-967-8888
Mailing Address - Fax:916-966-4501
Practice Address - Street 1:7916 PEBBLE BEACH DR
Practice Address - Street 2:SUITE #103
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7790
Practice Address - Country:US
Practice Address - Phone:916-967-8888
Practice Address - Fax:916-966-4501
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA648510OtherUNITED CONCORDIA