Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A00055090 | CA |
NPI | 1770519373 |
---|---|
Provider Name | Mr. Kenneth Mitchell Toft |
First Address | Roseville, CA 95678-1340 |
Second Address | Roseville, CA 95678-1340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 08/07/2007 |