Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A172280 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | R3499 | KY |
NPI | 1083023923 |
---|---|
Provider Name | Dr. Tyler Michael Gunn |
First Address | Torrance, CA 90504-5513 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2014 |
Last Update Date | 02/07/2021 |