Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS042090 | PA |
Y | 1223P0221X | Pediatric Dentist | 17295 | MD |
N | 1223P0221X | Pediatric Dentist | DN1868624 | MA |
NPI | 1003300740 |
---|---|
Provider Name | Dr. Yea Katie Nam |
First Address | Towson, MD 21204-4733 |
Second Address | Bel Air, MD 21015-5902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2018 |
Last Update Date | 09/07/2021 |