Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A101617 | CA |
Y | 207N00000X | Dermatologist | MD439500 | PA |
NPI | 1023288495 |
---|---|
Provider Name | Vanessa Ayumi London |
First Address | Philadelphia, PA 19114-1025 |
Second Address | Philadelphia, PA 19114-1025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2008 |
Last Update Date | 18/08/2010 |