Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G34668 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | G34668 | CA |
NPI | 1235175902 |
---|---|
Provider Name | Dr. William Francis Kivett |
First Address | Windsor, CA 95492-2196 |
Second Address | Santa Rosa, CA 95405-4817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 11/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46022 | (02) |