Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 155846 | CA |
Y | 208000000X | Pediatrician | MD-12641 | HI |
NPI | 1841369519 |
---|---|
Provider Name | Dr. Balram Gangaram |
First Address | San Francisco, CA 94158-2545 |
Second Address | San Francisco, CA 94158-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G39277 | (02) | HI |