Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | G78831 | CA |
NPI | 1437250859 |
---|---|
Provider Name | Kevin Bradley Kaiserman |
First Address | West Covina, CA 91790-3401 |
Second Address | West Covina, CA 91790-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G788310 | (05) | CA |
G68201 | (02) | CA |