Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 69561 | CT |
NPI | 1063806024 |
---|---|
Provider Name | Christine Bakhoum |
First Address | New Haven, CT 06510-3206 |
Second Address | New Haven, CT 06504-8901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 21/09/2021 |