Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | G64959 | AL |
NPI | 1194745828 |
---|---|
Provider Name | John Matthew Sum |
First Address | Saratoga, CA 95070-4037 |
Second Address | San Jose, CA 95128-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G649590 | (05) | CA |
F42757 | (02) | CA |