Healthcare Provider Details

I. General information

NPI: 1598785446
Provider Name (Legal Business Name): DR. KATHERINE LAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26741 PORTOLA PKWY SUITE 1-D
FOOTHILL RANCH CA
92610-1743
US

IV. Provider business mailing address

26741 PORTOLA PKWY SUITE 1-D
FOOTHILL RANCH CA
92610-1743
US

V. Phone/Fax

Practice location:
  • Phone: 949-581-4908
  • Fax: 949-581-9071
Mailing address:
  • Phone: 949-581-4908
  • Fax: 949-581-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: