Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | NONE | CA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | TL36720 | SC |
NPI | 1023272275 |
---|---|
Provider Name | Dr. Tom Theodore Karnezis |
First Address | Baldwin Park, CA 91706-5806 |
Second Address | Baldwin Park, CA 91706-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 21/12/2021 |