Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 30815 | CA |
NPI | 1023502176 |
---|---|
Provider Name | Katherine Powers |
First Address | Hayward, CA 94544-5760 |
Second Address | San Jose, CA 95134-1803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 20/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30815 | (05) | CA |