Healthcare Provider Details

I. General information

NPI: 1104739366
Provider Name (Legal Business Name): VIVIAN LOPEZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1298 KIFER RD STE 506
SUNNYVALE CA
94086-5320
US

IV. Provider business mailing address

PO BOX 611315
SAN JOSE CA
95161-1315
US

V. Phone/Fax

Practice location:
  • Phone: 408-735-7445
  • Fax:
Mailing address:
  • Phone: 408-735-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: