Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 059640 | NY |
NPI | 1053710673 |
---|---|
Provider Name | Dr. Ke Shang |
First Address | Rochester, NY 14618-2615 |
Second Address | Rochester, NY 14618-2615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 22/04/2020 |