Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA92829 | CA |
NPI | 1255956678 |
---|---|
Provider Name | Jane Vo |
First Address | Garden Grove, CA 92840-2016 |
Second Address | Garden Grove, CA 92840-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA92829 | (05) | CA |