Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 51177 | CA |
NPI | 1699826479 |
---|---|
Provider Name | Dr. Shadrouz Kianouri |
First Address | Bishop, CA 93514-8058 |
Second Address | Bishop, CA 93514-8058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 23/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1659433191 | EMPLOYER NPI (01) | CA |
EAP11576F | (05) | CA |
FHC11576 | (05) | CA |
THP11576F | (05) | CA |