Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 36137 | TX |
NPI | 1821521428 |
---|---|
Provider Name | Dr. Payam Patrick Kajeh |
First Address | Sugar Land, TX 77479-1781 |
Second Address | Brooklyn, NY 11220-2508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 18/09/2020 |