Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A105562 | CA |
N | 207KA0200X | Allergist | MT200406 | PA |
N | 208000000X | Pediatrician | A105562 | CA |
NPI | 1083872196 |
---|---|
Provider Name | Marc David Ikeda |
First Address | Sacramento, CA 95823-4671 |
Second Address | Sacramento, CA 95823-4671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2008 |
Last Update Date | 11/02/2022 |