Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A44590 | CA |
N | 208D00000X | General Practice Physician | A44590 | CA |
NPI | 1003024464 |
---|---|
Provider Name | Seyed Ali Khonsary |
First Address | Los Angeles, CA 90024-9763 |
Second Address | South Gate, CA 90280-2778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A44590 | PRIVATE INS. ID. (01) | CA |