Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | A74233 | CA |
Y | 2080P0205X | Pediatric Endocrinologist | A74233 | CA |
NPI | 1285641449 |
---|---|
Provider Name | Roger Kenji Long |
First Address | San Francisco, CA 94143-0434 |
Second Address | San Francisco, CA 94143-0434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 13/09/2012 |