Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A127300 | CA |
NPI | 1679902746 |
---|---|
Provider Name | Dr. Graham Fedorak |
First Address | Los Angeles, CA 90020-1117 |
Second Address | Los Angeles, CA 90020-1117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 08/11/2013 |