Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | CA39664 | CA |
NPI | 1013157536 |
---|---|
Provider Name | Dr. Diana Marie Kamminga |
First Address | Fremont, CA 94536-0295 |
Second Address | Fremont, CA 94536-1854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2009 |
Last Update Date | 23/02/2009 |