Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | D0080834 | MD |
NPI | 1023454899 |
---|---|
Provider Name | Dr. Shivangi Amin |
First Address | Frederick, MD 21702-4505 |
Second Address | Los Angeles, CA 90026-4005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2013 |
Last Update Date | 08/01/2019 |