Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 24796 | CA |
NPI | 1063664365 |
---|---|
Provider Name | Dr. Ellsworth Yin Kong Hew |
First Address | Woodland, CA 95695-2986 |
Second Address | Woodland, CA 95695-2986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2008 |
Last Update Date | 17/10/2008 |