Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ML60368638 | WA |
Y | 2080P0210X | Pediatric Nephrologist | A141224 | CA |
NPI | 1932441557 |
---|---|
Provider Name | Dr. Ken Sutha |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 03/07/2019 |