Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | A87554 | CA |
NPI | 1427121938 |
---|---|
Provider Name | John Seul |
First Address | Encinitas, CA 92024-5138 |
Second Address | Encinitas, CA 92024-5140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |