Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | C51411 | CA |
NPI | 1225066962 |
---|---|
Provider Name | Gurmander S Kohli |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 14/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C514110 | (05) | CA |
A34801 | (02) |