Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2007-01008 | NC |
N | 208600000X | Surgeon | 2007-01008 | NC |
N | 208200000X | Surgeon | A90965 | CA |
N | 208600000X | Surgeon | A90965 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 2007-01008 | NC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | A90965 | CA |
NPI | 1134346745 |
---|---|
Provider Name | Dr. John Y Um |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 17/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10026059800 | (05) | NE |