Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 054978 | NY |
NPI | 1083927644 |
---|---|
Provider Name | Angie Chin |
First Address | Oakland Gardens, NY 11364-2008 |
Second Address | Forest Hills, NY 11375-7318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2010 |
Last Update Date | 23/07/2010 |