Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | G44348 | CA |
NPI | 1144248881 |
---|---|
Provider Name | Dr. J. Dennis Steen |
First Address | Susanville, CA 96130-0754 |
Second Address | Susanville, CA 96130-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G443480 | (05) | CA |
A49619 | (02) | CA |