Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 34535 | CA |
NPI | 1104093533 |
---|---|
Provider Name | Dr. Patrick Keiji Ohara |
First Address | Montebello, CA 90640-7001 |
Second Address | Montebello, CA 90640-7001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 14/05/2008 |