Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A75677 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A75677 | CA |
N | 207ND0900X | Dermatopathologist | A75677 | CA |
N | 207NP0225X | Pediatric Dermatologist | A75677 | CA |
N | 207NS0135X | Procedural Dermatology | A75677 | CA |
NPI | 1114018173 |
---|---|
Provider Name | Vipal Soni |
First Address | Huntington Beach, CA 92647-6818 |
Second Address | Huntington Beach, CA 92647-6818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 10/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H73542 | (02) | CA |