Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 10373 | OR |
NPI | 1073809117 |
---|---|
Provider Name | Dr. Lin Zhu |
First Address | Midwest City, OK 73110-4866 |
Second Address | Oregon City, OR 97045-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 13/06/2019 |