Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DT-2089 | HI |
NPI | 1023226099 |
---|---|
Provider Name | Jason C Joe |
First Address | Honolulu, HI 96814-1609 |
Second Address | Honolulu, HI 96814-1609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 03/11/2008 |