Provider Demographics
NPI:1770593113
Name:HSU, KENNETH KON (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KON
Last Name:HSU
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 1:15845 CHANNEL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1441
Mailing Address - Country:US
Mailing Address - Phone:510-276-3711
Mailing Address - Fax:
Practice Address - Street 1:15845 CHANNEL ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1441
Practice Address - Country:US
Practice Address - Phone:510-276-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics