Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | A76475 | CA |
NPI | 1003910142 |
---|---|
Provider Name | Gabriel Gabbaypour |
First Address | Beverly Hills, CA 90210 |
Second Address | Beverly Hills, CA 90210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G9261001 | (05) | CA |
H87123 | (02) |