Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 50647 | CA |
NPI | 1144336306 |
---|---|
Provider Name | Miss Kelly June Dang |
First Address | San Jose, CA 95111-3021 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 18/04/2016 |