Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 19882 | NJ |
NPI | 1043457401 |
---|---|
Provider Name | Shahin Kazemi |
First Address | Cherry Hill, NJ 08034 |
Second Address | Cherry Hill, NJ 08034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 07/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11133 | DELTA (01) |