Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH-1391 | HI |
NPI | 1063931293 |
---|---|
Provider Name | Tiffanie P.o. Kimura |
First Address | Everett, WA 98201-1720 |
Second Address | Arlington, WA 98223-1652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2017 |
Last Update Date | 19/09/2017 |