Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 41181 | CA |
NPI | 1013024652 |
---|---|
Provider Name | Dr. John J Jaber |
First Address | San Leandro, CA 94577-4838 |
Second Address | San Leandro, CA 94577-4838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |