Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A32812 | CA |
NPI | 1619093374 |
---|---|
Provider Name | Dr. Raj Kanodia |
First Address | Beverly Hills, CA 90210-4532 |
Second Address | Beverly Hills, CA 90210-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |