Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 25165 | CA |
N | 1223E0200X | Endodontist | 25165 | CA |
NPI | 1124392766 |
---|---|
Provider Name | Dr. Thomas Alan Levy |
First Address | Los Angeles, CA 90089-0641 |
Second Address | Los Angeles, CA 90089-0641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2012 |
Last Update Date | 29/02/2012 |