Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 49256 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 49256 | CA |
NPI | 1083820039 |
---|---|
Provider Name | Dr. Thomas Ying |
First Address | Manhattan Beach, CA 90266 |
Second Address | Manhattan Beach, CA 90266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 11/11/2010 |