Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 104529 | CA |
NPI | 1093208076 |
---|---|
Provider Name | Dr. Ian Pearson |
First Address | Los Angeles, CA 90025-2276 |
Second Address | Valencia, CA 91355-5647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 01/10/2021 |