Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A49614 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | A49614 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A49614 | CA |
NPI | 1699853317 |
---|---|
Provider Name | Ehsan Sultani |
First Address | Elk Grove, CA 95624-5070 |
Second Address | Elk Grove, CA 95624-5070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 16/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1699853317 | FAMILY MEDICINE (01) | CA |
F33184 | (02) |