Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE00009663 | WA |
NPI | 1073658472 |
---|---|
Provider Name | Dr. Isaac C Fu |
First Address | Bonney Lake, WA 98391-8457 |
Second Address | Bonney Lake, WA 98391-8457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 21/05/2008 |