Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 192431 | NY |
Y | 207N00000X | Dermatologist | 20A6512 | CA |
NPI | 1053308239 |
---|---|
Provider Name | Dr. James Daniel Taft |
First Address | San Jose, CA 95119-1215 |
Second Address | Camarillo, CA 93010-2465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01840220 | (05) | NY |
G82040 | (02) | NY |