Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 24341 | CA |
NPI | 1073750907 |
---|---|
Provider Name | George Shinn |
First Address | Los Angeles, CA 90047-2604 |
Second Address | Los Angeles, CA 90047-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 14/01/2009 |