Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 36266 | CA |
NPI | 1083985741 |
---|---|
Provider Name | Dr. K. Moldenhauer |
First Address | Pasadena, CA 91101-2564 |
Second Address | Pasadena, CA 91101-2564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2012 |
Last Update Date | 25/01/2012 |