MEDICARE: KANGAROOHEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1659914653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANGAROOHEALTH, INC.

Provider Business Mailing Address
First Line	:	370 ELAN VILLAGE LN UNIT 220
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95134-2534
Country	:	US
Telephone Number	:	408-641-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 HANOVER ST
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94304-1118
Country	:	US
Telephone Number	:	408-641-5446
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. XIAOXU KANG
Credential	:	PHD
Telephone Number	:	408-641-5446

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/22/2019

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Directions to “KANGAROOHEALTH, INC. ” Practice Location

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