Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G76674 | CA |
NPI | 1609943828 |
---|---|
Provider Name | John K. Mayeno |
First Address | Panorama City, CA 91402-5423 |
Second Address | Panorama City, CA 91402-5423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 30/11/2021 |