Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 5901 | KY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 29938 | KY |
NPI | 1518917343 |
---|---|
Provider Name | Dr. George Kushner |
First Address | Louisville, KY 40292-0001 |
Second Address | Louisville, KY 40292-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 14/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60059011 | (05) | KY |
6405901700 | (05) | KY |
T77193 | (02) | KY |