Individual ProviderJohn Ihor KisDentistDental ProvidersPractice Address1500 Southgate Ave Ste 210, Daly City, CA 94015-2231(650) 756-0938(650) 345-1773PECOS EnrollmentBased on the most recent information from CMS, provider John Ihor Kis does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1174621213Provider TypeIndividualFull NameKis, John IhorTitleDr.CredentialDDSGenderMaleSole ProprietorNoEnumeration Date9/20/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address1500 Southgate Ave Ste 210, Daly City, CA 94015-2231Phone(650) 756-0938Fax(650) 756-1915Mailing LocationMailing Address148 30th Ave, San Mateo, CA 94403-2713Phone(650) 345-1773FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense033482California