Provider Demographics
NPI:1275653248
Name:KITA, EUGENE TETSUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:TETSUO
Last Name:KITA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 MARCO POLO WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4522
Mailing Address - Country:US
Mailing Address - Phone:650-697-3538
Mailing Address - Fax:
Practice Address - Street 1:1740 MARCO POLO WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4522
Practice Address - Country:US
Practice Address - Phone:650-697-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice