Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A164438 | CA |
N | 208600000X | Surgeon | A164438 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | A164438 | CA |
NPI | 1124555388 |
---|---|
Provider Name | Tatyana Polyak |
First Address | Sacramento, CA 95817 |
Second Address | Sacramento, CA 95817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2017 |
Last Update Date | 31/08/2020 |