Healthcare Provider Details

I. General information

NPI: 1639001282
Provider Name (Legal Business Name): ZOE QUINN WOLK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 S KERCKHOFF AVE
SAN PEDRO CA
90731-6743
US

IV. Provider business mailing address

3130 S KERCKHOFF AVE
SAN PEDRO CA
90731-6743
US

V. Phone/Fax

Practice location:
  • Phone: 310-200-4763
  • Fax:
Mailing address:
  • Phone: 310-200-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: