Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 7625 | NC |
NPI | 1073684866 |
---|---|
Provider Name | Dr. Jannie Im |
First Address | Mayfield Hts, OH 44124-6511 |
Second Address | Mayfield Hts, OH 44124-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |