Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 47810 | CA |
NPI | 1215134473 |
---|---|
Provider Name | Dr. Maggie T Chao |
First Address | Pleasanton, CA 94566 |
Second Address | Pleasanton, CA 94566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 28/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47810 | DENTAL LICENSE NUMBER (01) | CA |