Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 103152 | CA |
NPI | 1083177257 |
---|---|
Provider Name | Andrew Rich |
First Address | Oakland, CA 94602-1018 |
Second Address | Oakland, CA 94602-1018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2019 |
Last Update Date | 05/01/2021 |