Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DW 030765 | CA |
NPI | 1073657458 |
---|---|
Provider Name | Dr. John Esterkyn |
First Address | San Francisco, CA 94118-2503 |
Second Address | Antioch, CA 94509-4963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2007 |
Last Update Date | 08/07/2007 |