Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 26717 | CA |
NPI | 1003033614 |
---|---|
Provider Name | Dr. Michael T Vehawn |
First Address | San Jose, CA 95118-1500 |
Second Address | San Jose, CA 95118-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 25/04/2012 |