Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 33514 | TX |
NPI | 1033638093 |
---|---|
Provider Name | Dr. Vahid Khoshkam |
First Address | El Paso, TX 79936-1630 |
Second Address | El Paso, TX 79912-5579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2017 |
Last Update Date | 26/07/2019 |