Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | G6986 | CA |
NPI | 1295936615 |
---|---|
Provider Name | Dr. Stephan T Honda |
First Address | Hawthorne, CA 90250-3315 |
Second Address | Hawthorne, CA 90250-3315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 06/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G698600 | (05) | CA |
E90560 | (02) | CA |