Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 52401 | CA |
NPI | 1003012857 |
---|---|
Provider Name | Dr. Mirwais Hussainy |
First Address | Spring Valley, CA 91977-6737 |
Second Address | Santa Ana, CA 92707-7705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 08/07/2007 |