Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 11569 | MD |
N | 1223P0700X | Prosthodontist | 5618 | DC |
NPI | 1255627147 |
---|---|
Provider Name | Kambiz Fotoohi |
First Address | Chevy Chase, MD 20815 |
Second Address | Chevy Chase, MD 20815-7256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 19/04/2012 |