Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G36807 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | G36807 | CA |
NPI | 1265436620 |
---|---|
Provider Name | Dr. Kyle Wayne Coker |
First Address | Laguna Woods, CA 92637-3116 |
Second Address | Laguna Woods, CA 92637-3116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 16/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G368070 | (05) | CA |
00G368070G89 | CAL-OPTIMA (01) | CA |
A91818 | (02) | CA |
RR2000 22926 | MEDICARE RAILROAD (01) | CA |