=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730539545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PORCELAIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2016
-----------------------------------------------------
Last Update Date | 06/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 IVY ST #404
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-4385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-335-6905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3627 19TH ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-335-6905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-FOUNDER
-----------------------------------------------------
Name | MS. JOYCE H SOHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-335-6905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 50602
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------