Provider Demographics
NPI:1497206098
Name:POLONY, KATY
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:POLONY
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 1:3607 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4390
Mailing Address - Country:US
Mailing Address - Phone:510-706-9528
Mailing Address - Fax:
Practice Address - Street 1:3607 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4390
Practice Address - Country:US
Practice Address - Phone:510-706-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist