Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT292560 | CA |
N | 2251H1200X | Hand | PT292560 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT292560 | CA |
NPI | 1275077646 |
---|---|
Provider Name | Dr. Jordan S Istrin |
First Address | Beverly Hills, CA 90210-5718 |
Second Address | Beverly Hills, CA 90210-5718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 27/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT292560 | PT292560 (01) | CA |