Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DRP 548 | FL |
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS039414 | PA |
NPI | 1992958219 |
---|---|
Provider Name | Dr. Riya Mahesh Kuklani |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 21/05/2018 |