Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | A103412 | CA |
N | 207R00000X | Internist | A103412 | CA |
N | 111NI0900X | Internist | A103412 | CA |
N | 207RG0100X | Gastroenterologist | A103412 | CA |
NPI | 1639321839 |
---|---|
Provider Name | Dr. Kidist Kidane Yimam |
First Address | Los Altos, CA 94022-1408 |
Second Address | San Francisco, CA 94109-6978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A103412 | STATE MEDICAL LICENSE (01) | CA |