Provider Demographics
NPI:1992599351
Name:KABAFUSION SC, LLC
Entity type:Organization
Organization Name:KABAFUSION SC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENKENDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:800-435-3020
Mailing Address - Street 1:17777 CENTER COURT DR N STE 550
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9337
Mailing Address - Country:US
Mailing Address - Phone:800-435-3020
Mailing Address - Fax:
Practice Address - Street 1:5955 CORE RD STE 512
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6085
Practice Address - Country:US
Practice Address - Phone:888-211-7439
Practice Address - Fax:854-999-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy