Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G53411 | CA |
NPI | 1306853122 |
---|---|
Provider Name | Dr. Jon Isamu White |
First Address | Orange, CA 92856-6905 |
Second Address | Orange, CA 92868-3852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 28/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E08478 | (02) | CA |
G53411 | STATE LICENSE (01) | CA |