Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 63922 | CA |
NPI | 1053711192 |
---|---|
Provider Name | Eger Korolevsky |
First Address | Roseville, CA 95661-7747 |
Second Address | Roseville, CA 95661-7747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 09/11/2021 |