Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H007548 | AZ |
NPI | 1073042792 |
---|---|
Provider Name | Kimberly Ann Hoffman |
First Address | Scottsdale, AZ 85254-2360 |
Second Address | Phoenix, AZ 85042-6551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 19/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287386 | (05) | AZ |