Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A66233 | CA |
NPI | 1013952159 |
---|---|
Provider Name | Kenith K Paresa |
First Address | Beverly Hills, CA 90209-2354 |
Second Address | Los Angeles, CA 90048-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 20/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A662330 | (05) | CA |
27738 | (02) | CA |