Provider Demographics
NPI:1629280805
Name:KANUGI, JIM H (DDS)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:H
Last Name:KANUGI
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 1:660 H STREET
Mailing Address - Street 2:STE C
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-427-2940
Mailing Address - Fax:619-425-8116
Practice Address - Street 1:660 H STREET
Practice Address - Street 2:STE C
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-427-2940
Practice Address - Fax:619-425-8116
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist