Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G72658 | CA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G72658 | CA |
NPI | 1215949524 |
---|---|
Provider Name | Dr. Donald B. Longjohn |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 07/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G34560 | (02) | CA |