Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | C40996 | CA |
Y | 207WX0107X | Retina Specialist | C40996 | CA |
NPI | 1023197241 |
---|---|
Provider Name | Dr. Joseph Sidikaro |
First Address | Beverly Hills, CA 90210-5006 |
Second Address | Beverly Hills, CA 90210-5006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C40996 | (02) | CA |