Provider Demographics
NPI:1942620505
Name:PANGILINAN, KATHLEEN SEGURA (RDH ; RDHAP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SEGURA
Last Name:PANGILINAN
Suffix:
Gender:F
Credentials:RDH ; RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16314 GLEN ALDER CT
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6512
Mailing Address - Country:US
Mailing Address - Phone:562-217-3195
Mailing Address - Fax:
Practice Address - Street 1:16314 GLEN ALDER CT
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-6512
Practice Address - Country:US
Practice Address - Phone:562-217-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 514124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist