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General NPI Number Information
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NPI Number | 1679307102
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Entity Type | Individual
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Provider Name | KATIE HAGAN DDS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 2460 MISSION ST STE 106
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2430
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Country | US
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Telephone | 415-849-9991
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Fax |
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Provider Business Mailing Address
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Address Line | 236 BENTON AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94112-1108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 110548
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License Number State | CA
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