Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 51160 | CA |
Y | 213EG0000X | General Practice | 51160 | CA |
NPI | 1003830464 |
---|---|
Provider Name | Kelli Junker |
First Address | Newport Beach, CA 92660-8604 |
Second Address | Newport Beach, CA 92660-7601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 03/02/2011 |