Provider Demographics
NPI:1962905125
Name:KJ CABUGAO DDS INC
Entity type:Organization
Organization Name:KJ CABUGAO DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABUGAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:415-683-7523
Mailing Address - Street 1:3220 BEARD RD STE B
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3403
Mailing Address - Country:US
Mailing Address - Phone:707-252-1950
Mailing Address - Fax:707-252-7165
Practice Address - Street 1:3220 BEARD RD STE B
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3403
Practice Address - Country:US
Practice Address - Phone:707-252-1950
Practice Address - Fax:707-252-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty