Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN22058 | MA |
NPI | 1043428253 |
---|---|
Provider Name | Dr. Yong-Han Koo |
First Address | Wayland, MA 01778-1836 |
Second Address | Wayland, MA 01778-1836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2007 |
Last Update Date | 19/12/2011 |