Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 102471 | CA |
NPI | 1093206815 |
---|---|
Provider Name | Dr. Henry Ma |
First Address | San Jose, CA 95132-2885 |
Second Address | San Ramon, CA 94582-4969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |