Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A71305 | CA |
Y | 207VX0201X | Gynecologic Oncologist | A71305 | CA |
NPI | 1467547398 |
---|---|
Provider Name | Mr. Mark Wakabayashi |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 26/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A713050 | (05) | CA |
F30950 | (02) |