Individual
DR. JOHANES MARTIN ISMAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DR, SAN DIEGO, CA 92134
(619) 385-3683
Mailing address
NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DR, SAN DIEGO, CA 92134-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A113980
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VAD0000
—
CA
Enumeration date
06/22/2009
Last updated
06/06/2023
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