Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 46612 | CA |
NPI | 1003946443 |
---|---|
Provider Name | Dr. Nina Izraylevich |
First Address | San Francisco, CA 94118-3048 |
Second Address | San Francisco, CA 94118-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |