Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 158089 | CA |
NPI | 1073931077 |
---|---|
Provider Name | Daniel In Chung |
First Address | Roseville, CA 95661-3027 |
Second Address | Roseville, CA 95661-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 17/12/2021 |