Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 023066 | NY |
NPI | 1043414519 |
---|---|
Provider Name | Mrs. Alla A Kandkhorov |
First Address | Forest Hills, NY 11375-1049 |
Second Address | New York, NY 10016-3903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 08/07/2007 |