Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G52355 | CA |
NPI | 1124054853 |
---|---|
Provider Name | Dwite D Dahms |
First Address | Thousand Oaks, CA 91361-1023 |
Second Address | Thousand Oaks, CA 91361-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52239 | (02) | CA |
AD2654487 | DEA NUMBER (01) | CA |