Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | A88168 | CA |
NPI | 1659452720 |
---|---|
Provider Name | Dr. Sanjeev Dutta |
First Address | Stanford, CA 94305 |
Second Address | Stanford, CA 94305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A881680 | MEDICAL (01) | CA |
OTH000 | (02) | CA |