Provider Demographics
NPI:1124094214
Name:KIEU, DANIEL D (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:KIEU
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 1:4100 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3820
Mailing Address - Country:US
Mailing Address - Phone:316-612-0270
Mailing Address - Fax:316-612-0353
Practice Address - Street 1:4100 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3820
Practice Address - Country:US
Practice Address - Phone:316-612-0270
Practice Address - Fax:316-612-0353
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000116536OtherBCBS OF KANSAS
KS100359900AMedicaid
KS102885OtherDORAL PROVIDER NUMBER