Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 103957 | CA |
NPI | 1003478223 |
---|---|
Provider Name | Dr. Delano Hankins |
First Address | Los Angeles, CA 90008-1003 |
Second Address | Playa Del Rey, CA 90293-7985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2019 |
Last Update Date | 08/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103957 | (05) | CA |