Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 01064955A | IN |
Y | 207YS0123X | Facial Plastic Surgeon | A109191 | CA |
NPI | 1679747307 |
---|---|
Provider Name | Dr. Hootan Zandifar |
First Address | Los Angeles, CA 90048-5901 |
Second Address | Los Angeles, CA 90048-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2008 |
Last Update Date | 12/08/2009 |