Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 58840 | CA |
NPI | 1003140146 |
---|---|
Provider Name | Noor Khedraki |
First Address | Orange, CA 92868-4525 |
Second Address | Orange, CA 92868-4525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 22/09/2009 |