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General NPI Number Information
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NPI Number | 1871112052
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Entity Type | Organization
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Legal Business Name | KJ CABUGAO DDS INC
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 301 ALAMO DR STE I
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City | VACAVILLE
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State | CA
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Zip | 95688-4246
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Country | US
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Telephone | 707-446-4644
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Fax |
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Provider Business Mailing Address
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Address Line | 11 DUFFY CT
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City | PLEASANT HILL
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State | CA
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Zip | 94523-1707
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Country | US
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Telephone | 415-683-7523
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN JAMES CABUGAO
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Credential | DDS, MBA
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Telephone | 415-683-7523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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