Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 2013009580 | MO |
NPI | 1689872368 |
---|---|
Provider Name | Dr. John Jeonhwan Chi |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Creve Coeur, MO 63141-6431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200006351 | (05) | MO |