Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 36792 | CA |
NPI | 1073678413 |
---|---|
Provider Name | Dr. Lyndon Sumon Low |
First Address | Stockton, CA 95207-5606 |
Second Address | Stockton, CA 95207-5606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |