Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | G76489 | CA |
Y | 207NS0135X | Procedural Dermatology | G76489 | CA |
NPI | 1184777948 |
---|---|
Provider Name | Dr. Wendy Hoffman |
First Address | Beverly Hills, CA 90210-4211 |
Second Address | Beverly Hills, CA 90210-4211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
954220697 | TAX ID # (01) | CA |
BH3758123 | DEA (01) | CA |
G65548 | (02) | CA |
G76489 | MEDICAL LICENSE (01) | CA |