Provider Demographics
NPI:1588875397
Name:LOUIE, KENNETH GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GREGORY
Last Name:LOUIE
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 1:749 TARAVAL ST
Mailing Address - Street 2:#101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2520
Mailing Address - Country:US
Mailing Address - Phone:415-681-9020
Mailing Address - Fax:415-681-9004
Practice Address - Street 1:749 TARAVAL ST
Practice Address - Street 2:#101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2520
Practice Address - Country:US
Practice Address - Phone:415-681-9020
Practice Address - Fax:415-681-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice