Provider Demographics
NPI:1811784564
Name:KENCANA HEALTHCARE INC
Entity type:Organization
Organization Name:KENCANA HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DION
Authorized Official - Middle Name:ADIPUTRA
Authorized Official - Last Name:KENCANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-580-3071
Mailing Address - Street 1:217 N LINCOLN AVE APT A
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-1729
Mailing Address - Country:US
Mailing Address - Phone:714-580-3071
Mailing Address - Fax:
Practice Address - Street 1:525 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1202
Practice Address - Country:US
Practice Address - Phone:626-573-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty