Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 16607 | MA |
NPI | 1134323975 |
---|---|
Provider Name | Dr. Darrly J Lung |
First Address | Boston, MA 02110-2510 |
Second Address | Boston, MA 02110-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1790838225 | GROUP (01) | MA |