Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | G31646 | CA |
NPI | 1942393095 |
---|---|
Provider Name | Joseph August Church |
First Address | Los Angeles, CA 90028-7901 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G316460 | (05) | CA |
A91354 | (02) | CA |