Provider Demographics
NPI:1255438354
Name:UYESUGI, KAZUYA (DDS)
Entity type:Individual
Prefix:DR
First Name:KAZUYA
Middle Name:
Last Name:UYESUGI
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 1:974 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2344
Mailing Address - Country:US
Mailing Address - Phone:408-279-4337
Mailing Address - Fax:408-279-4555
Practice Address - Street 1:974 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2344
Practice Address - Country:US
Practice Address - Phone:408-279-4337
Practice Address - Fax:408-279-4555
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000033866OtherDELTA DENTAL
CA770131080OtherTAX ID USED FOR OTHER INS
CA970422OtherUNITED CONCORDIA