Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | C32109 | CA |
NPI | 1063634434 |
---|---|
Provider Name | Jack N Levin |
First Address | Los Altos, CA 94024-6767 |
Second Address | Los Altos, CA 94024-6767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AL5825457 | DEA NUMBER (01) | CA |
C32109 | STATE LICENSE (01) | CA |
Q422490 | (02) | CA |