Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 39573 | CA |
NPI | 1003925769 |
---|---|
Provider Name | Dr. Robin Chikako Wakabayashi |
First Address | Los Angeles, CA 90013-1647 |
Second Address | Los Angeles, CA 90013-1647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |