Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | OS012172 | PA |
NPI | 1336150564 |
---|---|
Provider Name | Dr. Kamran Shayesteh |
First Address | Johnstown, PA 15905-4305 |
Second Address | Johnstown, PA 15901-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 14/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1025321390001 | (05) | PA |