Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 30679 | CA |
NPI | 1003454489 |
---|---|
Provider Name | Emmeline Lui |
First Address | San Rafael, CA 94901-5411 |
Second Address | San Rafael, CA 94901-5411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2019 |
Last Update Date | 16/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30679 | DENTAL HYGIENE BOARD OF CALIFORNIA (01) | CA |