Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 80006 | MA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 80006 | MA |
NPI | 1194716290 |
---|---|
Provider Name | Dr. David A. Kieff |
First Address | Wellesley, MA 02481-2184 |
Second Address | Wellesley, MA 02481-2184 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 22/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3179770 | (05) | MA |
G75417 | (02) | MA |