Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 36878 | CA |
NPI | 1124232640 |
---|---|
Provider Name | Dr. Thomas Jovicich |
First Address | Encino, CA 91316-2805 |
Second Address | Encino, CA 91316-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |