Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A061933 | CA |
NPI | 1083782478 |
---|---|
Provider Name | Mr. Kambiz Hannani |
First Address | West Covina, CA 91790-3938 |
Second Address | West Covina, CA 91790-3938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H47532 | (02) | CA |