Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 28337 | CA |
NPI | 1033509799 |
---|---|
Provider Name | Kim Twilling |
First Address | Auburn, CA 95603-9522 |
Second Address | Auburn, CA 95603-9522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |