Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 7025 | NV |
NPI | 1124524236 |
---|---|
Provider Name | Kristin Chino |
First Address | Venice, CA 90291-8607 |
Second Address | Venice, CA 90291-8607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2018 |
Last Update Date | 05/04/2018 |