Healthcare Provider Details

I. General information

NPI: 1083159511
Provider Name (Legal Business Name): KYLA DUNN MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD LUCILE PACKARD CHILDREN'S HOSPITAL
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

750 WELCH RD STE 305 STANFORD CHILDREN'S HEALTH-PEDIATRIC CARDIOLOGY
PALO ALTO CA
94304-1510
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-2121
  • Fax: 650-497-8422
Mailing address:
  • Phone: 650-736-8767
  • Fax: 650-724-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: