Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A109678 | CA |
Y | 111NI0900X | Internist | A109678 | CA |
NPI | 1003127986 |
---|---|
Provider Name | Assefa Worku |
First Address | San Jose, CA 95119-1103 |
Second Address | San Jose, CA 95119-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 15/12/2021 |