Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D009285 | AZ |
N | 1223G0001X | General Practice | D009285 | AZ |
N | 213EG0000X | General Practice | D009285 | AZ |
Y | 1223P0700X | Prosthodontist | D009285 | AZ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | D009285 | AZ |
NPI | 1194019638 |
---|---|
Provider Name | Richard Yee Hernandez |
First Address | Scottsdale, AZ 85260-6279 |
Second Address | Scottsdale, AZ 85260-6279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 30/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |
P01198325 | RAILROAD MEDICARE (01) | MN |