Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A52110 | CA |
NPI | 1326082876 |
---|---|
Provider Name | Dr. Kousha Zarnegar |
First Address | Glendora, CA 91740-3801 |
Second Address | West Covina, CA 91790-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 09/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A521100 | (05) | CA |
G45709 | (02) | CA |