Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 41845 | CA |
NPI | 1033794201 |
---|---|
Provider Name | Mr. Mured Kakar |
First Address | Corte Madera, CA 94925-1721 |
Second Address | San Anselmo, CA 94960-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2021 |
Last Update Date | 10/03/2021 |