Provider Demographics
NPI:1174194278
Name:EVON CADOGAN MD INC
Entity Type:Organization
Organization Name:EVON CADOGAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-801-2012
Mailing Address - Street 1:920 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5759
Mailing Address - Country:US
Mailing Address - Phone:888-801-2012
Mailing Address - Fax:408-762-5948
Practice Address - Street 1:2242 CAMDEN AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2029
Practice Address - Country:US
Practice Address - Phone:888-801-2012
Practice Address - Fax:408-762-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty