Provider Demographics
NPI:1316782188
Name:KINNE, ERIN DOREENA (RDHAP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:DOREENA
Last Name:KINNE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:DOREENA
Other - Last Name:SOLOVAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDHAP
Mailing Address - Street 1:17654 WELBY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5335
Mailing Address - Country:US
Mailing Address - Phone:818-325-7433
Mailing Address - Fax:
Practice Address - Street 1:17654 WELBY WAY
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-5335
Practice Address - Country:US
Practice Address - Phone:818-325-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20034124Q00000X
CA1075125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist