Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A75009 | CA |
NPI | 1013010685 |
---|---|
Provider Name | Dr. Michael Kermani |
First Address | Newport Beach, CA 92658 |
Second Address | Newport Beach, CA 92660-7721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 20/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A750090 | (05) | CA |
H47530 | (02) | CA |