Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 95004887 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 95004887 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95004887 | CA |
NPI | 1043760069 |
---|---|
Provider Name | Dongyon Roh |
First Address | San Diego, CA 92123-1338 |
Second Address | Palmdale, CA 93551-4599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2016 |
Last Update Date | 26/06/2018 |