Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A43431 | CA |
NPI | 1023167418 |
---|---|
Provider Name | Mr. Ahmad Matin |
First Address | Beverly Hills, CA 90212 |
Second Address | Beverly Hills, CA 90212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A29690 | (02) |