Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 17262 | CA |
NPI | 1962512376 |
---|---|
Provider Name | Dr. George W Than |
First Address | Diamond Bar, CA 91765 |
Second Address | Diamond Bar, CA 91765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 06/03/2012 |