Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 57545 | GA |
NPI | 1437290004 |
---|---|
Provider Name | Kshitij Vipin Majmundar |
First Address | Atlanta, GA 31193-3087 |
Second Address | Roswell, GA 30076-1146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
57545 | MEDICAL LICENSE (01) | GA |