Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G084198 | CA |
NPI | 1033551783 |
---|---|
Provider Name | Michael Kitt |
First Address | Mountain View, CA 94040-4581 |
Second Address | Mountain View, CA 94040-4581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2013 |
Last Update Date | 23/07/2013 |