Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A89365 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A89365 | CA |
NPI | 1750500609 |
---|---|
Provider Name | Gus Kalioundji |
First Address | Beverly Hills, CA 90212-3518 |
Second Address | Beverly Hills, CA 90212-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 07/12/2021 |