Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 42041 | TN |
Y | 207T00000X | Neurosurgeon | MD.14773R | LA |
NPI | 1073738613 |
---|---|
Provider Name | Anthony Hunkyun Sin |
First Address | Shreveport, LA 71103-3822 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 02/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1057100 | (05) | LA |
4K720F600 | MEDICARE - PTAN (01) | LA |