Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 38025 | CA |
NPI | 1053595926 |
---|---|
Provider Name | Dr. Kim Austin |
First Address | Los Angeles, CA 90008-3606 |
Second Address | Los Angeles, CA 90008-3606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 27/12/2007 |