Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E5117 | CA |
N | 213ES0131X | Foot Surgery | RESIDENT | FL |
NPI | 1154618122 |
---|---|
Provider Name | Marat Kazak |
First Address | Fair Oaks, CA 95628-3158 |
Second Address | Fair Oaks, CA 95628-3158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CA128837 | (02) | CA |