Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A82593 | CA |
NPI | 1093940298 |
---|---|
Provider Name | Bao Ngoc To |
First Address | Jersey Village, TX 77065-5641 |
Second Address | Houston, TX 77090-2543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2009 |
Last Update Date | 03/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
280139101 | (05) | TX |
8CU599 | BCBS (01) | TX |