Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 58035 | CA |
NPI | 1063620383 |
---|---|
Provider Name | Dr. Samuel Gegamian |
First Address | Los Angeles, CA 90004-4404 |
Second Address | Los Angeles, CA 90004-4404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 19/10/2020 |