Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 45222 | CA |
NPI | 1003011172 |
---|---|
Provider Name | Sonia Khullar |
First Address | Los Angeles, CA 90004 |
Second Address | Los Angeles, CA 90004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B45222 | HFP (01) | CA |
G92829 | DENTICAL (01) | CA |