Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G34237 | CA |
NPI | 1063590776 |
---|---|
Provider Name | Andrew S. Klonecke |
First Address | Oakland, CA 94612-3429 |
Second Address | Sacramento, CA 95825-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G342370 | (05) | CA |
A45841 | (02) |