Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BP10047617 | TX |
N | 111NI0900X | Internist | BP10047617 | TX |
Y | 207RH0000X | Hematologist | A139997 | CA |
NPI | 1225476484 |
---|---|
Provider Name | Salman Otoukesh |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 17/06/2019 |