Provider Demographics
NPI:1659914653
Name:KANGAROOHEALTH, INC.
Entity Type:Organization
Organization Name:KANGAROOHEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOXU
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-641-5446
Mailing Address - Street 1:370 ELAN VILLAGE LN UNIT 220
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2534
Mailing Address - Country:US
Mailing Address - Phone:408-641-5446
Mailing Address - Fax:
Practice Address - Street 1:2627 HANOVER ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1118
Practice Address - Country:US
Practice Address - Phone:408-641-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care