Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | TEP6871 | NE |
Y | 2080P0202X | Pediatric Cardiologist | 33833 | OK |
NPI | 1023364890 |
---|---|
Provider Name | Aswathy Kumar Vaikom House |
First Address | Oklahoma City, OK 73104-5047 |
Second Address | Oklahoma City, OK 73104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 02/01/2019 |