Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | G86699 | CA |
N | 2086X0206X | Surgical Oncologist | MD-5132 | HI |
NPI | 1467438952 |
---|---|
Provider Name | Dr. Scott Alfred Hundahl |
First Address | Mather, CA 95655-4200 |
Second Address | Mather, CA 95655-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E58507 | (02) | HI |