Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A60972 | CA |
NPI | 1003809187 |
---|---|
Provider Name | Denise Lu-Gee Hom |
First Address | Agoura Hills, CA 91301-4337 |
Second Address | Simi Valley, CA 93063-2186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H31949 | (02) |