Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 25MA09071200 | NJ |
N | 207N00000X | Dermatologist | 266475 | NY |
N | 207N00000X | Dermatologist | MD12915 | RI |
N | 207N00000X | Dermatologist | MD465852 | PA |
N | 207ND0900X | Dermatopathologist | 25MA09071200 | NJ |
Y | 207ND0900X | Dermatopathologist | 266475 | NY |
N | 207ND0900X | Dermatopathologist | MA09071200 | RI |
N | 207ND0900X | Dermatopathologist | MD465852 | PA |
NPI | 1194950683 |
---|---|
Provider Name | Dr. Jisun Cha |
First Address | New York, NY 10005-1549 |
Second Address | New York, NY 10006-2562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0315176 | (05) | NJ |