Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A62461 | CA |
N | 2080N0001X | Neonatal-Perinatal Doctor | A62461 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | A62461 | CA |
NPI | 1104908094 |
---|---|
Provider Name | Malik Oscar White |
First Address | San Jose, CA 95128-2604 |
Second Address | Tarzana, CA 91356-3501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 02/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A624610 | (05) | CA |