Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 173729-1205 | UT |
Y | 207Q00000X | Family Doctor | G156448 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 173729-1205 | UT |
N | 207QS0010X | Family Doctor - Sports Medicine | G156448 | CA |
NPI | 1023058278 |
---|---|
Provider Name | Dr. Kathryn Allen |
First Address | Newport Beach, CA 92659-8699 |
Second Address | Fountain Valley, CA 92708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 13/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D07229 | (02) | UT |