Provider Demographics
NPI:1407421456
Name:KAO HOLDINGS
Entity Type:Organization
Organization Name:KAO HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD DOCTORE
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWAKARE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPANEYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-759-5547
Mailing Address - Street 1:5920 SARATOGA BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4119
Mailing Address - Country:US
Mailing Address - Phone:361-779-7648
Mailing Address - Fax:
Practice Address - Street 1:5920 SARATOGA BLVD STE 370
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4119
Practice Address - Country:US
Practice Address - Phone:361-779-7648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1497899298Medicaid
MA1699186429Medicaid
TX1477928331Medicaid