Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 000094 | NY |
NPI | 1073987970 |
---|---|
Provider Name | Dr. Kamolthip Songtrakul |
First Address | New York, NY 10010-4020 |
Second Address | New York, NY 10010-4020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2015 |
Last Update Date | 13/09/2018 |