Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G29773 | CA |
NPI | 1770605495 |
---|---|
Provider Name | Dr. David J Kiener |
First Address | Sacramento, CA 95815-4314 |
Second Address | Roseville, CA 95661-2866 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 07/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0400011479 | RR MEDICARE PIN (01) | CA |
A44154 | (02) | CA |