Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 37316 | CA |
NPI | 1003022211 |
---|---|
Provider Name | Mr. Steve H Bolur |
First Address | West Los Angeles, CA 90025 |
Second Address | West Los Angeles, CA 90025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |