Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 54599 | CA |
NPI | 1073699963 |
---|---|
Provider Name | Dr. Stacey M Woo |
First Address | Anaheim, CA 92807 |
Second Address | Anaheim, CA 92807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 30/06/2021 |