Provider Demographics
NPI:1386808277
Name:HANDA, LISA SHIZUKO (RDHAP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:SHIZUKO
Last Name:HANDA
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 1:3555 SO EL CAMINO REAL
Mailing Address - Street 2:420
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3415
Mailing Address - Country:US
Mailing Address - Phone:650-570-3042
Mailing Address - Fax:
Practice Address - Street 1:3555 SO EL CAMINO REAL
Practice Address - Street 2:420
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3415
Practice Address - Country:US
Practice Address - Phone:650-570-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 116124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist