Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A81697 | CA |
NPI | 1104923879 |
---|---|
Provider Name | Dr. Preben Brandenhoff |
First Address | San Francisco, CA 94109-3479 |
Second Address | San Francisco, CA 94109-3479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 02/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H56210 | (02) | CA |