Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 93318 | CA |
NPI | 1366052177 |
---|---|
Provider Name | Salman Golchoub |
First Address | North Hollywood, CA 91601-4004 |
Second Address | North Hollywood, CA 91601-4004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2020 |
Last Update Date | 06/08/2020 |