Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 63593 | CA |
NPI | 1316475213 |
---|---|
Provider Name | Dr. Kyle Burke Jones |
First Address | San Francisco, CA 94115-3011 |
Second Address | San Francisco, CA 94115-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 16/07/2019 |