Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 29039 | CA |
NPI | 1699837096 |
---|---|
Provider Name | Dr. Alfred Shoalan Ding |
First Address | Fremont, CA 94538 |
Second Address | Fremont, CA 94538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 23/02/2011 |