Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DR 60288665 | WA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DDS60860 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DR60288665 | WA |
NPI | 1487965828 |
---|---|
Provider Name | Dr. Mehdi B Matin |
First Address | San Diego, CA 92130-2659 |
Second Address | San Diego, CA 92121-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 01/04/2018 |