Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | A150383 | CA |
N | 208200000X | Surgeon | 2016025186 | MO |
N | 208600000X | Surgeon | 2016025186 | MO |
NPI | 1629374020 |
---|---|
Provider Name | Dr. Kambiz Etesami |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 25/09/2020 |