Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A166090 | CA |
NPI | 1154717692 |
---|---|
Provider Name | Daniel Chendana Sukato |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-2012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 22/12/2021 |