Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 41122 | CA |
NPI | 1073761334 |
---|---|
Provider Name | Menachem Oren |
First Address | Sherman Oaks, CA 91401-5142 |
Second Address | Canoga Park, CA 91303-2828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/08/2008 |