Provider Demographics
NPI:1700952801
Name:JU, KEVIN (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:JU
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 1:44439 17TH ST W STE 201
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39345 10TH ST W
Practice Address - Street 2:BUILDING B
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3779
Practice Address - Country:US
Practice Address - Phone:661-274-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice