Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 20635 | CA |
NPI | 1063614402 |
---|---|
Provider Name | Mr. John G Hockin II |
First Address | Upland, CA 91786 |
Second Address | Upland, CA 91786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |