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Individual
MR. KULIN TANTOD
Active
Individual
MR. KULIN TANTOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A109655
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FA068Y
INDIVIDUAL PTAN
CA
01
—
W14158
GROUP PTAN
CA
01
—
ZZZ20041Z
GROUP PTAN
CA
Enumeration date
10/21/2008
Last updated
05/03/2012
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