Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G79315 | CA |
N | 208200000X | Surgeon | G79315 | CA |
N | 208600000X | Surgeon | G79315 | CA |
NPI | 1073539060 |
---|---|
Provider Name | Paul A Kedeshian |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 22/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G793150 | (05) | CA |
H32724 | (02) | CA |