Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A137860 | CA |
NPI | 1003227372 |
---|---|
Provider Name | Dr. Jonathan Okman |
First Address | Vallejo, CA 94590-2929 |
Second Address | Vallejo, CA 94590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 05/07/2018 |