Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | $$$$$$$$$ | MN |
NPI | 1174966683 |
---|---|
Provider Name | David Yang |
First Address | Maplewood, MN 55119-5953 |
Second Address | Maplewood, MN 55119-5953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 15/04/2013 |