Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 65087 | CA |
N | 213EG0000X | General Practice | 65087 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 65087 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 65087 | CA |
NPI | 1225487622 |
---|---|
Provider Name | Dr. Alexander John Mcmahon |
First Address | Los Angeles, CA 90025 |
Second Address | Los Angeles, CA 90095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 18/12/2018 |