MEDICARE: ANNA KROKEE RDHAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	300	CA
2	124Q00000X	Dental Hygienist	22521	CO

General Provider Information

NPI Number	:	1194038125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA KROKEE RDHAP

Provider Business Mailing Address
First Line	:	1253 OPAL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1833
Country	:	US
Telephone Number	:	858-220-9087
Fax Number	:	858-488-4250

Provider Business Practice Location Address
First Line	:	1253 OPAL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1833
Country	:	US
Telephone Number	:	858-220-9087
Fax Number	:	858-488-4250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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