Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 23507 | NE |
N | 208200000X | Surgeon | A92674 | CA |
N | 208600000X | Surgeon | A92674 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A92674 | CA |
NPI | 1659329209 |
---|---|
Provider Name | Ali Khoynezhad |
First Address | Long Beach, CA 90808-1793 |
Second Address | Long Beach, CA 90808-1793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 28/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47078557583 | (05) | NE |
I48774 | (02) | NE |