Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 37203 | CA |
N | 1223X0400X | Orthodontists | D10570 | OR |
NPI | 1003093642 |
---|---|
Provider Name | Dr. Jady L Chiakowsky |
First Address | Pebble Beach, CA 93953-2937 |
Second Address | Monterey, CA 93940-6113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2008 |
Last Update Date | 24/11/2021 |