Provider Demographics
NPI:1013091552
Name:EUGENIA KUTSENKO
Entity Type:Organization
Organization Name:EUGENIA KUTSENKO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTSENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-265-4064
Mailing Address - Street 1:3535 ROSS AVE
Mailing Address - Street 2:#304
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-265-4064
Mailing Address - Fax:408-265-9876
Practice Address - Street 1:3535 ROSS AVE
Practice Address - Street 2:#304
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-265-4064
Practice Address - Fax:408-265-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4472201OtherDETICAL 1999