Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A142610 | CA |
Y | 208600000X | Surgeon | A142610 | CA |
N | 2082S0105X | Plastic Hand Surgeon | A142610 | CA |
NPI | 1104246339 |
---|---|
Provider Name | Dr. Michael Delong |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-8358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2014 |
Last Update Date | 27/07/2021 |