Provider Demographics
NPI:1851122287
Name:KBK GROUP
Entity type:Organization
Organization Name:KBK GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:PISHEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-596-7312
Mailing Address - Street 1:13080 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1902
Mailing Address - Country:US
Mailing Address - Phone:832-596-7312
Mailing Address - Fax:
Practice Address - Street 1:13080 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1902
Practice Address - Country:US
Practice Address - Phone:832-596-7312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821434978Medicaid