Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 100547 | CA |
NPI | 1003369075 |
---|---|
Provider Name | Dr. Sami Shahhal |
First Address | San Marcos, CA 92069-3545 |
Second Address | San Marcos, CA 92069-3545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2016 |
Last Update Date | 26/07/2016 |