Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | CA45333 | CA |
NPI | 1063510287 |
---|---|
Provider Name | Sony Thomas |
First Address | Arcadia, CA 91007-7361 |
Second Address | Arcadia, CA 91007-7361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |