Provider Demographics
NPI:1255829370
Name:HIRANO KANUGA DENTAL GROUP
Entity Type:Organization
Organization Name:HIRANO KANUGA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHUKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANUGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:310-463-5027
Mailing Address - Street 1:18580 VIA PRINCESSA STE 3
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-8329
Mailing Address - Country:US
Mailing Address - Phone:661-388-0499
Mailing Address - Fax:
Practice Address - Street 1:18580 VIA PRINCESSA STE 3
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-8329
Practice Address - Country:US
Practice Address - Phone:661-388-0499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577641223P0221X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790975597Medicaid