Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | G63445 | CA |
Y | 207Q00000X | Family Doctor | G063445 | CA |
NPI | 1720108525 |
---|---|
Provider Name | Dr. Allen H Green |
First Address | Los Angeles, CA 90025-6613 |
Second Address | Los Angeles, CA 90025-6613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 10/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BG0714142 | DEA (01) | CA |
E07527 | (02) | CA |