Healthcare Provider Details

I. General information

NPI: 1013091552
Provider Name (Legal Business Name): EUGENIA KUTSENKO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 ROSS AVE #304
SAN JOSE CA
95124
US

IV. Provider business mailing address

3535 ROSS AVE #304
SAN JOSE CA
95124
US

V. Phone/Fax

Practice location:
  • Phone: 408-265-4064
  • Fax: 408-265-9876
Mailing address:
  • Phone: 408-265-4064
  • Fax: 408-265-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. EUGENIA KUTSENKO
Title or Position: DENTIST
Credential: DDS
Phone: 408-265-4064