Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 46222 | CA |
NPI | 1033274212 |
---|---|
Provider Name | Derrick S Tanihara |
First Address | Sacramento, CA 95825 |
Second Address | Folsom, CA 95630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |