Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 34731 | CA |
NPI | 1215169420 |
---|---|
Provider Name | Ms. Marjorie Christiane Kiss |
First Address | La Verne, CA 91750-1958 |
Second Address | Arcadia, CA 91006-3750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 20/08/2009 |