Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A25158 | CA |
NPI | 1003181058 |
---|---|
Provider Name | Bahjat Kurd-Misto |
First Address | Coto De Caza, CA 92679-3630 |
Second Address | Coto De Caza, CA 92679-3630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2012 |
Last Update Date | 14/11/2013 |