Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G778170 | CA |
NPI | 1003816141 |
---|---|
Provider Name | Timothy Kirkor Atmajian |
First Address | Fresno, CA 93706-9748 |
Second Address | Fresno, CA 93706-9748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006778170 | (05) | CA |
I24605 | (02) |