Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A88034 | CA |
N | 2080P0201X | Pediatric Allergist | A88034 | CA |
NPI | 1447376454 |
---|---|
Provider Name | Dr. Raffi Tachdjian |
First Address | Santa Monica, CA 90404-2087 |
Second Address | Santa Monica, CA 90404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 02/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I72058 | (02) | CA |