Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G64131 | CA |
NPI | 1780761643 |
---|---|
Provider Name | Kenneth R.k. Nielsen |
First Address | Oakland, CA 94612-3429 |
Second Address | Santa Clara, CA 95051-5329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G641310 | (05) | CA |
F82945 | (02) |