Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G30063 | CA |
Y | 208600000X | Surgeon | G30063 | CA |
NPI | 1023094984 |
---|---|
Provider Name | Stephen Louis Kuchenbecker |
First Address | Santa Monica, CA 90404 |
Second Address | Santa Monica, CA 90404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A44277 | (02) |