Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | G64875 | CA |
NPI | 1063406163 |
---|---|
Provider Name | Dr. David James Koster |
First Address | Fresno, CA 93720-3347 |
Second Address | Fresno, CA 93720-3347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 05/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F16249 | (02) | |
PO1345510 | RAILROAD MEDICARE (01) | CA |
ZZZ75882Z | (05) | CA |