Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A52757 | CA |
NPI | 1043398001 |
---|---|
Provider Name | Dikran Bairamian |
First Address | Modesto, CA 95350-6131 |
Second Address | Modesto, CA 95350-6131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A527570 | MEDICAL PIN (01) | |
F66405 | (02) |