Provider Demographics
NPI:1194931386
Name:LEE, KENNETH KIANFU (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KIANFU
Last Name:LEE
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 1:5620 WILBUR AVE. SUITE 319
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1351
Mailing Address - Country:US
Mailing Address - Phone:818-344-4210
Mailing Address - Fax:818-344-4093
Practice Address - Street 1:5620 WILBUR AVE. SUITE 319
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-344-4210
Practice Address - Fax:818-344-4093
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-373345-01OtherDENTI-CAL PROVIDER