Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 2527051 | NY |
Y | 207YS0123X | Facial Plastic Surgeon | A90465 | CA |
NPI | 1669500302 |
---|---|
Provider Name | Dr. Kristin Egan |
First Address | Manhattan Beach, CA 90266-2727 |
Second Address | Manhattan Beach, CA 90266-2727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 22/12/2016 |