Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 27508 | CA |
NPI | 1003258559 |
---|---|
Provider Name | Phoebe Chenh |
First Address | San Jose, CA 95123-5943 |
Second Address | San Jose, CA 95123-5943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2013 |
Last Update Date | 25/07/2013 |