Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 050471 | NY |
NPI | 1154430965 |
---|---|
Provider Name | Dr. Wayne Kye |
First Address | Woodside, NY 11377-4472 |
Second Address | Woodside, NY 11377-4472 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |