Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | A167718 | CA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A167718 | CA |
NPI | 1194110700 |
---|---|
Provider Name | Cong Ran |
First Address | Tarzana, CA 91357-7001 |
Second Address | Santa Monica, CA 90401-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 06/04/2021 |