Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | A030767 | CA |
NPI | 1124010483 |
---|---|
Provider Name | Dr. William David Koltun |
First Address | San Diego, CA 92108-5859 |
Second Address | San Diego, CA 92108-5859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A26225 | (02) | CA |