Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 32337 | TX |
Y | 213EG0000X | General Practice | 32337 | TX |
NPI | 1003362062 |
---|---|
Provider Name | Dr. Tae Eun You |
First Address | Dallas, TX 75231-4574 |
Second Address | Dallas, TX 75217-1760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2016 |
Last Update Date | 30/08/2016 |