Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 46867 | CA |
NPI | 1003803065 |
---|---|
Provider Name | Nick Levi |
First Address | San Francisco, CA 94111-4301 |
Second Address | San Francisco, CA 94111-4301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 08/07/2007 |