Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G27055 | CA |
Y | 111NI0900X | Internist | G27055 | CA |
N | 207RR0500X | Rheumatology | G27055 | CA |
NPI | 1093804304 |
---|---|
Provider Name | Kenneth E Nyman |
First Address | Tarzana, CA 91356-4218 |
Second Address | Tarzana, CA 91356-3647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 25/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093804304 | NPI (01) | CA |
1992894240 | GROUP NPI (01) | CA |
A91021 | (02) | CA |