Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 56425 | CA |
NPI | 1003003641 |
---|---|
Provider Name | Ryan Partnoff |
First Address | Pasadena, CA 91101-2009 |
Second Address | Pasadena, CA 91101-2009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 17/09/2008 |