Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 26199 | CA |
NPI | 1023182144 |
---|---|
Provider Name | Dr. Randy Q. Ligh |
First Address | San Jose, CA 95128-1869 |
Second Address | San Jose, CA 95128-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |