Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01063381A | IN |
Y | 207Q00000X | Family Doctor | 41402 | KY |
NPI | 1003000902 |
---|---|
Provider Name | Jaivanti Lohano |
First Address | Louisville, KY 40212-1033 |
Second Address | Louisville, KY 40212-1033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100065920 | (05) | KY |