Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A128697 | CA |
NPI | 1568783470 |
---|---|
Provider Name | Dr. Dana Kristopher Petersen |
First Address | San Francisco, CA 94118-1507 |
Second Address | San Francisco, CA 94118-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2010 |
Last Update Date | 02/08/2021 |