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NPI Code Detail

MEDICARE: STEPHANIE GIM RDHAP

MEDICARE: STEPHANIE GIM 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
1124Q00000XDental HygienistHAP 518CA

General Provider Information

NPI Number : 1780091595
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE GIM RDHAP
Provider Business Mailing Address
First Line : 1423 ALAMEDA DE LAS PULGAS
Second Line :
City : SAN MATEO
State : CA
Zip : 94402-3407
Country : US
Telephone Number : 650-302-1284
Fax Number :
Provider Business Practice Location Address
First Line : 1423 ALAMEDA DE LAS PULGAS
Second Line :
City : SAN MATEO
State : CA
Zip : 94402-3407
Country : US
Telephone Number : 650-302-1284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2014
Last Update Date : 07/14/2014

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