Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 40500 | CA |
NPI | 1255487179 |
---|---|
Provider Name | Leonid A Tolstunov |
First Address | San Francisco, CA 94127-1633 |
Second Address | San Francisco, CA 94127-1303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2019 |