Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E1641 | CA |
NPI | 1073576161 |
---|---|
Provider Name | Dr. Richard T Koenigsberg |
First Address | Sunnyvale, CA 94087-1941 |
Second Address | Sunnyvale, CA 94087-1941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11018 | (02) | CA |