Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 27643 | CA |
NPI | 1134297088 |
---|---|
Provider Name | Dr. John William Leyman |
First Address | Long Beach, CA 90803-3401 |
Second Address | Long Beach, CA 90803-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 21/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
853 | GENERAL ANESTHESIA PERMIT (01) | CA |
U29093 | (02) | CA |