Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | D7858 | OR |
NPI | 1417940289 |
---|---|
Provider Name | Dr. Joel Kenneth Hopkin |
First Address | Salem, OR 97302-1267 |
Second Address | Salem, OR 97302-1267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 23/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
230636 | (05) | OR |
U63165 | (02) |