Provider Demographics
NPI:1184689085
Name:J&K ORTHOPEDICS INC
Entity Type:Organization
Organization Name:J&K ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED ORTHOTIST
Authorized Official - Phone:909-621-1180
Mailing Address - Street 1:320 E BONITA AVENUE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-621-1180
Mailing Address - Fax:909-624-1650
Practice Address - Street 1:320 E BONITA AVENUE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-621-1180
Practice Address - Fax:909-624-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000770Medicaid
CAGXC000770Medicaid