Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC213880 | CA |
Y | 213ER0200X | Radiology | DC213880 | CA |
NPI | 1154340222 |
---|---|
Provider Name | Dr. John P Kern |
First Address | Brentwood, CA 94513-1582 |
Second Address | Brentwood, CA 94513-1582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 01/08/2011 |