Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 53248 | CA |
NPI | 1013120518 |
---|---|
Provider Name | Jonathan Kiyomi Nakano |
First Address | Thousand Oaks, CA 91360-5808 |
Second Address | Thousand Oaks, CA 91360-5808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 18/04/2012 |