Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G47007 | CA |
NPI | 1124082847 |
---|---|
Provider Name | Dr. Ken D. Pischel |
First Address | Los Angeles, CA 90074-0001 |
Second Address | La Jolla, CA 92037-1027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 26/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G470070 | (05) | CA |
F26707 | (02) | CA |