Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D20656 | CA |
NPI | 1033117965 |
---|---|
Provider Name | Dr. John K Pearson |
First Address | Corona, CA 92882-4348 |
Second Address | Corona, CA 92882-4348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 08/07/2007 |