Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SL6858 | CA |
NPI | 1033625264 |
---|---|
Provider Name | Komal G Kumar |
First Address | Orange, CA 92869-2885 |
Second Address | Irvine, CA 92606-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2017 |
Last Update Date | 26/12/2017 |