Provider Demographics
NPI:1467064980
Name:INAN KURUGOL, PELIN
Entity Type:Individual
Prefix:
First Name:PELIN
Middle Name:
Last Name:INAN KURUGOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PELIN
Other - Middle Name:
Other - Last Name:INAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1690 WOODSIDE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3402
Mailing Address - Country:US
Mailing Address - Phone:650-556-6673
Mailing Address - Fax:
Practice Address - Street 1:1690 WOODSIDE RD STE 118
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3402
Practice Address - Country:US
Practice Address - Phone:650-365-1400
Practice Address - Fax:415-474-2186
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice