Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | L1093 | TX |
NPI | 1144300419 |
---|---|
Provider Name | Andrew Joseph Kienstra |
First Address | Austin, TX 78746-1285 |
Second Address | Austin, TX 78723-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
047555001 | (05) | TX |
G92957 | (02) |