Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | CA24047 | CA |
NPI | 1003012501 |
---|---|
Provider Name | Dr. Jay R. Perko I |
First Address | Visalia, CA 93277-2810 |
Second Address | Visalia, CA 93277-2810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |