Provider Demographics
NPI:1659105765
Name:KAN, JONATHAN (DMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 VISTA HILL TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3207
Mailing Address - Country:US
Mailing Address - Phone:510-299-6315
Mailing Address - Fax:
Practice Address - Street 1:2344 MCKEE RD STE 45
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1616
Practice Address - Country:US
Practice Address - Phone:408-729-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist