Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | G60579 | CA |
NPI | 1083770440 |
---|---|
Provider Name | Dr. Jon Masao Nakamoto |
First Address | Rancho Santa Margarita, CA 92688-5595 |
Second Address | San Juan Capistrano, CA 92675-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F49083 | (02) | CA |