Provider Demographics
NPI:1427144039
Name:LOUIE, KENNETH G (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:LOUIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:G
Other - Last Name:LOUIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2844 SUMMIT ST
Mailing Address - Street 2:STE 109
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3641
Mailing Address - Country:US
Mailing Address - Phone:510-444-7277
Mailing Address - Fax:
Practice Address - Street 1:2844 SUMMIT ST
Practice Address - Street 2:STE 109
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3641
Practice Address - Country:US
Practice Address - Phone:510-444-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB33800-01Medicaid