Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 80318 | CA |
NPI | 1215378039 |
---|---|
Provider Name | Ghezal Balkhi |
First Address | Fremont, CA 94538-2984 |
Second Address | Fremont, CA 94536-3809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 09/07/2013 |