Provider Demographics
NPI:1295875904
Name:KANAGAKI, GORDON K (DDS)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:K
Last Name:KANAGAKI
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 1:7176 SANTA TERESA BLVD
Mailing Address - Street 2:B-4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95139-1351
Mailing Address - Country:US
Mailing Address - Phone:408-226-7760
Mailing Address - Fax:408-226-8179
Practice Address - Street 1:7176 SANTA TERESA BLVD
Practice Address - Street 2:B-4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139-1351
Practice Address - Country:US
Practice Address - Phone:408-226-7760
Practice Address - Fax:408-226-8179
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice