Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 015772 | MO |
NPI | 1932538410 |
---|---|
Provider Name | Behjat Moghadam |
First Address | Kansas City, MO 64108-2716 |
Second Address | Kansas City, MO 64108-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 05/11/2013 |