Provider Demographics
NPI:1841155538
Name:KUSUHARA FAMILY DENTISTRT
Entity type:Organization
Organization Name:KUSUHARA FAMILY DENTISTRT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSUHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-772-7720
Mailing Address - Street 1:18907 NORDHOFF ST STE 46
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3796
Mailing Address - Country:US
Mailing Address - Phone:818-772-7720
Mailing Address - Fax:
Practice Address - Street 1:18907 NORDHOFF ST STE 46
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3796
Practice Address - Country:US
Practice Address - Phone:818-772-7720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-16
Last Update Date:2025-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty