Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 52382 | CA |
NPI | 1023109428 |
---|---|
Provider Name | Dr. Jad S Elkhoury |
First Address | Sonoma, CA 95476 |
Second Address | Sonoma, CA 95476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |