Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | G81209 | CA |
NPI | 1134214901 |
---|---|
Provider Name | Dr. Harry Kallas |
First Address | Fresno, CA 93710-5269 |
Second Address | Fresno, CA 93710-5269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 25/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E98253 | (02) | CA |
ZZZ71868Z | (05) | CA |