Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN1856291 | MA |
NPI | 1053750893 |
---|---|
Provider Name | Dr. Allan Wun |
First Address | Lakewood, CO 80227 |
Second Address | Boston, MA 02111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 14/06/2013 |