Provider Demographics
NPI:1063122034
Name:HARY, KATRINA (RDHAP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:HARY
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 LA CRUZ AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2407
Mailing Address - Country:US
Mailing Address - Phone:650-438-5609
Mailing Address - Fax:
Practice Address - Street 1:224 LA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2407
Practice Address - Country:US
Practice Address - Phone:650-438-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist