Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G87964 | CA |
N | 208600000X | Surgeon | G87964 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G87964 | CA |
NPI | 1144302993 |
---|---|
Provider Name | Mr. Simon K. Ashiku JR. |
First Address | Oakland, CA 94611-5641 |
Second Address | Oakland, CA 94611-5641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G07787 | (02) | MA |