Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A83763 | CA |
N | 208600000X | Surgeon | A83763 | CA |
Y | 2082S0105X | Plastic Hand Surgeon | A83763 | CA |
NPI | 1093833980 |
---|---|
Provider Name | Dr. Bauback Safa |
First Address | San Francisco, CA 94114-1010 |
Second Address | San Francisco, CA 94114-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 07/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A83763 | MEDICAL LICENSE (01) | CA |
BS8361329 | DEA (01) | CA |