Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22273 | MA |
Y | 213EG0000X | General Practice | 22273 | MA |
N | 1223P0700X | Prosthodontist | DN22273 | MA |
NPI | 1083870687 |
---|---|
Provider Name | Dr. Sophana Hem |
First Address | Winchester, MA 01890-1961 |
Second Address | Winchester, MA 01890-1961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2008 |
Last Update Date | 27/12/2016 |