Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A35327 | CA |
NPI | 1104881523 |
---|---|
Provider Name | Dr. Mohan Priyakantha Kumaratne |
First Address | Huntington Beach, CA 92647-6837 |
Second Address | Huntington Beach, CA 92647-6837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A353270 | (05) | CA |