Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | C34663 | CA |
NPI | 1033282512 |
---|---|
Provider Name | Dr. Julian M Whitaker |
First Address | Newport Beach, CA 92660-1923 |
Second Address | Newport Beach, CA 92660-1923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 16/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A35694 | (02) | CA |