Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | A56138 | CA |
NPI | 1215025044 |
---|---|
Provider Name | Ivan I Kirov |
First Address | Orange, CA 92868-3835 |
Second Address | Orange, CA 92868-3835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A561380 | (05) | CA |
G98668 | (02) | CA |