Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A98869 | CA |
Y | 2080P0205X | Pediatric Endocrinologist | A98869 | CA |
NPI | 1104061407 |
---|---|
Provider Name | Dr. Jyotsna Keni |
First Address | Fountain Valley, CA 92708-4008 |
Second Address | Fountain Valley, CA 92708-4008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2008 |
Last Update Date | 29/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A98869 | MEDICAL LICENSE NUMBER (01) | CA |
FK2167472 | DEA NUMBER (01) | CA |