Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A105169 | CA |
NPI | 1003013442 |
---|---|
Provider Name | Dr. Jack Min Kan |
First Address | Newport Beach, CA 92663 |
Second Address | Newport Beach, CA 92663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 22/11/2019 |