Provider Demographics
NPI:1790975597
Name:KANUGA, SHUKAN C (DDS)
Entity Type:Individual
Prefix:
First Name:SHUKAN
Middle Name:C
Last Name:KANUGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20640 PESARO WAY
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4158
Mailing Address - Country:US
Mailing Address - Phone:818-671-1230
Mailing Address - Fax:
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 330
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1910
Practice Address - Country:US
Practice Address - Phone:818-346-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577641223P0221X
WADR200001941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry