Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant |
NPI | 1629127436 |
---|---|
Provider Name | Mr. Kevin Atwood Kirschner |
First Address | Corona, CA 92882-3136 |
Second Address | Corona, CA 92882-3136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TG009 | (02) | CA |