Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 050421 | NY |
N | 1223X0400X | Orthodontists | 22DI02339100 | NJ |
NPI | 1063630358 |
---|---|
Provider Name | Dr. Man Ki So |
First Address | New York, NY 10016-1721 |
Second Address | Brooklyn, NY 11234-5217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |