Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 51590 | CA |
NPI | 1164448064 |
---|---|
Provider Name | Dr. Keven Scott Herold |
First Address | San Diego, CA 92103-4978 |
Second Address | San Diego, CA 92103-4978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |