Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 41894 | CA |
NPI | 1104946458 |
---|---|
Provider Name | Dr. Emad W Bassali |
First Address | Sherman Oaks, CA 91403-1773 |
Second Address | Sherman Oaks, CA 91403-1773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |