Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | G44996 | CA |
NPI | 1659404333 |
---|---|
Provider Name | Dr. Michael A Persky |
First Address | Encino, CA 91436-2124 |
Second Address | Encino, CA 91436-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 18/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP1242798 | (02) |