Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 95005493 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95005493 | CA |
NPI | 1265975148 |
---|---|
Provider Name | Daisy Klith |
First Address | San Francisco, CA 94145-0680 |
Second Address | Georgetown, CA 95634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 04/06/2019 |