Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | AF7229455 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | AF7229455 | CA |
NPI | 1417953043 |
---|---|
Provider Name | Dr. Sidney Mark Fishman |
First Address | Los Alamitos, CA 90720-6901 |
Second Address | Los Alamitos, CA 90720-6901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 27/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G305900 | (05) | CA |
A44476 | (02) | CA |