Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | VUT006538 | NY |
NPI | 1063481000 |
---|---|
Provider Name | Dr. Melissa Koom Joo Lee- Kung |
First Address | New York, NY 10021-5663 |
Second Address | New York, NY 10021-5663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 17/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A400026217 | (02) |