Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A126262 | CA |
NPI | 1205093895 |
---|---|
Provider Name | Dr. Kristofer Jason Jones |
First Address | Los Angeles, CA 90049-6711 |
Second Address | Los Angeles, CA 90095-6902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 01/08/2013 |