Provider Demographics
NPI:1477609014
Name:KENNETH ABE, D.D.S. A PROFESSIONAL CORP
Entity type:Organization
Organization Name:KENNETH ABE, D.D.S. A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-941-2168
Mailing Address - Street 1:843 ALTOS OAKS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5422
Mailing Address - Country:US
Mailing Address - Phone:650-941-2168
Mailing Address - Fax:
Practice Address - Street 1:843 ALTOS OAKS DR STE 1
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5422
Practice Address - Country:US
Practice Address - Phone:650-941-2168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty