Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 225913 | MA |
N | 207Q00000X | Family Doctor | A120608 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 235987 | MA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A120608 | CA |
NPI | 1205042470 |
---|---|
Provider Name | Dr. Scott Kaiser |
First Address | Santa Monica, CA 90404-2050 |
Second Address | Santa Monica, CA 90404-2050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 15/04/2021 |