Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | C141557 | CA |
NPI | 1205082393 |
---|---|
Provider Name | Mr. Oleg Georgievich Kovalenko |
First Address | Sacramento, CA 95816-5122 |
Second Address | Sacramento, CA 95816-5122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 06/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2961657 | (05) | OH |