Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 30-019917 | OH |
Y | 1223P0221X | Pediatric Dentist | 30019917 | OH |
NPI | 1003901059 |
---|---|
Provider Name | Homa Amini |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43215-7508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2580309 | (05) | OH |