MEDICARE: KATHLEEN HANLEY RDH

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	15469	CA

General Provider Information

NPI Number	:	1750406088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN HANLEY RDH

Provider Business Mailing Address
First Line	:	1162 FASSLER AVE
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-3655
Country	:	US
Telephone Number	:	650-355-3267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1749 TARAVAL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-2308
Country	:	US
Telephone Number	:	415-753-0790
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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