Healthcare Provider Details

I. General information

NPI: 1184689085
Provider Name (Legal Business Name): J&K ORTHOPEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 ARROW HWY STE 100
MONTCLAIR CA
91763-1664
US

IV. Provider business mailing address

5405 ARROW HWY STE 100
MONTCLAIR CA
91763-1664
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-1180
  • Fax: 909-625-7535
Mailing address:
  • Phone: 909-621-1180
  • Fax: 909-625-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. LANCE RAY CLAWSON
Title or Position: PRESIDENT
Credential: CPO
Phone: 909-621-1180