Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 60746 | CA |
NPI | 1265509921 |
---|---|
Provider Name | Dr. Steven Isaac Ganzberg |
First Address | Los Angeles, CA 90095-1668 |
Second Address | Los Angeles, CA 90095-1668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 17/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T22004 | (02) |