Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 159772 | NY |
NPI | 1003873472 |
---|---|
Provider Name | Dr. Chris L Kjolhede |
First Address | Cooperstown, NY 13326-0725 |
Second Address | Cooperstown, NY 13326-1301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01488531 | (05) | NY |
B70758 | (02) | NY |