Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 37903 | TX |
NPI | 1174294045 |
---|---|
Provider Name | Dr. Minh Van |
First Address | Sugar Land, TX 77478-5143 |
Second Address | Katy, TX 77449-6844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 22/09/2021 |