Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G25224 | CA |
N | 111NI0900X | Internist | G25224 | CA |
N | 207RC0200X | Critical Care Medicine | G25224 | CA |
Y | 207RP1001X | Pulmonary Disease | G25224 | CA |
NPI | 1073609780 |
---|---|
Provider Name | Dr. Dale Edward Kocienski |
First Address | Daly City, CA 94017-2180 |
Second Address | Daly City, CA 94015-2223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 03/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G252241 | MEDICARE PTAN (01) | CA |
00G252242 | (05) | CA |
05D0593905 | CLIA (01) | CA |
A42576 | (02) | CA |