Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E5769 | CA |
Y | 222Z00000X | Podiatrist | E5769 | CA |
NPI | 1053809160 |
---|---|
Provider Name | Chase Dahl |
First Address | Long Beach, CA 90802-3848 |
Second Address | Tampa, FL 33612-4745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 21/07/2021 |