Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | P3373 | TX |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2010-02022 | NC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A112455 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD 28074 | SC |
NPI | 1124117486 |
---|---|
Provider Name | Dr. Jonathan Sol Kulbersh |
First Address | Charlotte, NC 28210-3393 |
Second Address | Charlotte, NC 28210-3393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 15/10/2012 |