Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G77298 | CA |
NPI | 1023105160 |
---|---|
Provider Name | Dr. Jonathan M Davidorf |
First Address | West Hills, CA 91307-1468 |
Second Address | West Hills, CA 91307-1468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 28/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G772980 | (05) | CA |
F89244 | (02) | CA |