Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G16872 | CA |
N | 208600000X | Surgeon | G16872 | CA |
N | 2086X0206X | Surgical Oncologist | G16872 | CA |
NPI | 1457476780 |
---|---|
Provider Name | Dr. David Sievers |
First Address | Tarzana, CA 91356-2804 |
Second Address | Tarzana, CA 91356-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G168720 | (05) | CA |
00G168720 | BLUE SHIELD (01) | CA |
A90456 | (02) | |
G16872 | PIN (01) | CA |
G16872 | TRICARE (01) |