Individual
TATYANA PETUKHOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., M.S.
Contact information
Practice address
156 WILLIAM ST FL 11, NEW YORK, NY 10038-5323
(646) 962-3376
Mailing address
3301 C ST STE 1300, UC DAVIS DEPARTMENT OF DERMATOLOGY, SACRAMENTO, CA 95816-3370
(408) 885-6300
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
A131981
CA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
293685
NY
207NS0135X
Procedural Dermatology Physician
293685
NY
Other
Enumeration date
03/25/2013
Last updated
01/11/2019
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