Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | A67816 | CA |
NPI | 1013070499 |
---|---|
Provider Name | Dr. Arthur Jeng |
First Address | Playa Vista, CA 90094-2137 |
Second Address | Sylmar, CA 91342-1437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A67816 | MEDICAL LICENSE (01) | CA |