Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 100042 | CA |
N | 1223G0001X | General Practice | 60319 | KS |
N | 213EG0000X | General Practice | 60319 | KS |
NPI | 1306856356 |
---|---|
Provider Name | Dr. Jon Young Willingham |
First Address | Walnut Creek, CA 94596-4043 |
Second Address | Concord, CA 94518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 03/04/2018 |