Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G49623 | CA |
NPI | 1104912336 |
---|---|
Provider Name | Dr. David Koroshec |
First Address | Pasadena, CA 91106-1305 |
Second Address | Los Angeles, CA 90057-2402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 18/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G496230 | (05) | CA |
C96242 | (02) | CA |