Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC0202400 | CA |
NPI | 1073707568 |
---|---|
Provider Name | Albert Kahn |
First Address | San Jose, CA 95116-2437 |
Second Address | San Jose, CA 95116-2437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |