Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 033155 | CA |
NPI | 1124353628 |
---|---|
Provider Name | Dr. Sue Jane Quon |
First Address | San Francisco, CA 94121-0001 |
Second Address | San Francisco, CA 94121-1545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2009 |
Last Update Date | 02/02/2017 |