Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 20A5184 | CA |
NPI | 1053497578 |
---|---|
Provider Name | Stephen T. Sesody |
First Address | Oakland, CA 94612-3429 |
Second Address | Gilroy, CA 95020-7303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX51840 | (05) | CA |
F13396 | (02) |