Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | C52532 | CA |
N | 111NI0900X | Internist | C52532 | CA |
Y | 207RG0100X | Gastroenterologist | C52532 | CA |
NPI | 1033163985 |
---|---|
Provider Name | Mr. Michael C Jean |
First Address | Valencia, CA 91355-3708 |
Second Address | Newhall, CA 91321-2409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
813114 | (05) | AZ |
H89968 | (02) |