Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A168110 | CA |
NPI | 1144609314 |
---|---|
Provider Name | Jacob Bingham |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 08/10/2020 |