Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A25649 | CA |
NPI | 1003865593 |
---|---|
Provider Name | Montra M Kanok |
First Address | Upland, CA 91786 |
Second Address | Upland, CA 91786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A256490 | (05) | CA |
A24519 | (02) | |
A25649 | LIC (01) | CA |
AK7756628 | DEA (01) | CA |