Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 62621 | CA |
Y | 1223E0200X | Endodontist | 62621 | CA |
NPI | 1093106825 |
---|---|
Provider Name | Dr. Florence Kwo Au |
First Address | Walnut Creek, CA 94598-1451 |
Second Address | Antioch, CA 94509-6254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2015 |
Last Update Date | 17/03/2018 |