Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A25862 | CA |
NPI | 1184675357 |
---|---|
Provider Name | Michael K.c. Kan |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 18/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A258620 | (05) | CA |
A24612 | (02) | CA |