Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 51574 | CA |
NPI | 1003235763 |
---|---|
Provider Name | Dr. Charity Lucille Duncan Kachalia |
First Address | San Ramon, CA 94582-5784 |
Second Address | San Ramon, CA 94582-4935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 10/04/2014 |