Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 175981 | CA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 175981 | CA |
NPI | 1063166700 |
---|---|
Provider Name | Dr. Jason Philip Aaron Hiro Corban |
First Address | Montreal, QUEBEC H3G 1B2 |
Second Address | Los Angeles, CA 90033-1352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2022 |
Last Update Date | 11/02/2022 |