Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | OP60766680 | WA |
NPI | 1336240845 |
---|---|
Provider Name | Dr. Biju Daniel Kunjummen |
First Address | Eden Prairie, MN 55344-5349 |
Second Address | Eden Prairie, MN 55344-5349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 30/11/2021 |