Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | AL |
NPI | 1104405687 |
---|---|
Provider Name | Bokyung Chun |
First Address | Montgomery, AL 36106-1506 |
Second Address | Montgomery, AL 36106-1506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2021 |
Last Update Date | 03/04/2021 |