Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G80259 | CA |
NPI | 1245242767 |
---|---|
Provider Name | Dr. Ashton A. Kaidi |
First Address | Yucaipa, CA 92399-0697 |
Second Address | Newport Beach, CA 92660-7721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 30/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F80131 | (02) | CA |