Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 35.133639 | OH |
NPI | 1053756452 |
---|---|
Provider Name | Vikrum Thimmappa |
First Address | Los Angeles, CA 90074-0001 |
Second Address | Loma Linda, CA 92354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2013 |
Last Update Date | 07/08/2019 |