Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 55253 | CA |
NPI | 1144408725 |
---|---|
Provider Name | Dr. Jackie Chi |
First Address | West Covina, CA 91792-3195 |
Second Address | West Covina, CA 91792-3195 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2008 |
Last Update Date | 05/02/2015 |