Provider Demographics
NPI:1063050870
Name:DUDOROFF, KATHRYN TAYLOR
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:TAYLOR
Last Name:DUDOROFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5374 MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1519
Mailing Address - Country:US
Mailing Address - Phone:925-383-1166
Mailing Address - Fax:
Practice Address - Street 1:5374 MYRTLE DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1519
Practice Address - Country:US
Practice Address - Phone:925-383-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant