Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G47720 | CA |
NPI | 1124186754 |
---|---|
Provider Name | Colin I. Joyo |
First Address | Laguna Hills, CA 92653-3692 |
Second Address | Laguna Hills, CA 92653-3692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G477200D06 | (05) | CA |
1750339479 | GROUP NPI (01) | CA |
A50789 | (02) | CA |
AJ8579851 | DEA (01) | CA |
G47720 | LICENSE (01) | CA |
GR002729 | (05) | CA |