Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G75154 | CA |
NPI | 1144387952 |
---|---|
Provider Name | Dr. Jonathan David Shifren |
First Address | Newport Beach, CA 92660-7812 |
Second Address | Newport Beach, CA 92660-7812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 18/10/2007 |