Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 100294 | CA |
NPI | 1003471053 |
---|---|
Provider Name | Dr. Diana Sedler |
First Address | Los Angeles, CA 90015-3498 |
Second Address | Burbank, CA 91505-4339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 06/05/2019 |