Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | A601614 | CA |
NPI | 1205868445 |
---|---|
Provider Name | Dr. Krishnansu Sujata Tewari |
First Address | Los Angeles, CA 90051-3980 |
Second Address | Orange, CA 92868-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G88718 | (02) | CA |