Provider Demographics
NPI:1972960631
Name:CABRILLO FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:CABRILLO FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JEN KIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-359-1646
Mailing Address - Street 1:669 CRESPI DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:669 CRESPI DR
Practice Address - Street 2:SUITE F
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3486
Practice Address - Country:US
Practice Address - Phone:650-359-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty