Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | E4265 | CA |
Y | 213ES0131X | Foot Surgery | E4265 | CA |
NPI | 1144326729 |
---|---|
Provider Name | Dr. Pane Aksone Nouvong |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-2007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E4265 | CA DPM LIC (01) | CA |