Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 53943 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A115872 | CA |
NPI | 1346403169 |
---|---|
Provider Name | Miraj Kishor Sanghvi |
First Address | Stockton, CA 95207-4232 |
Second Address | Stockton, CA 95207-4232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 20/10/2011 |