Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 35448 | TX |
NPI | 1023539269 |
---|---|
Provider Name | Altan Kihm |
First Address | San Francisco, CA 94124-1726 |
Second Address | Boston, MA 02111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2017 |
Last Update Date | 26/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122300000X | (05) | CA |