Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 30016206 | OH |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DC028329 | CA |
NPI | 1053475806 |
---|---|
Provider Name | Dr. Dick Mah Hom |
First Address | Concord, CA 94519 |
Second Address | Concord, CA 94519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |