Healthcare Provider Details

I. General information

NPI: 1255829370
Provider Name (Legal Business Name): HIRANO KANUGA DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18580 VIA PRINCESSA STE 3
CANYON COUNTRY CA
91387-8329
US

IV. Provider business mailing address

18580 VIA PRINCESSA STE 3
CANYON COUNTRY CA
91387-8329
US

V. Phone/Fax

Practice location:
  • Phone: 661-388-0499
  • Fax:
Mailing address:
  • Phone: 661-388-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number57764
License Number StateCA

VIII. Authorized Official

Name: SHUKAN KANUGA
Title or Position: PARTNER
Credential: DDS, MSD
Phone: 310-463-5027