Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G65802 | CA |
NPI | 1669700712 |
---|---|
Provider Name | Thomas E Kaniff |
First Address | Reno, NV 89533-4120 |
Second Address | Sacramento, CA 95825-4813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2009 |
Last Update Date | 01/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C51258 | (02) | CA |