Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 41370 | CA |
NPI | 1063057941 |
---|---|
Provider Name | Ms. Kaclica Chhin |
First Address | Austin, TX 78753-2658 |
Second Address | Huntington Beach, CA 92647-2752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |