Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22410 | NJ |
NPI | 1073575635 |
---|---|
Provider Name | Sathya Kallur |
First Address | Toms River, NJ 08753-7643 |
Second Address | Toms River, NJ 08753-7643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 08/07/2007 |