Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1740803444 |
---|---|
Provider Name | Dr. Zach Zhishuo Ou |
First Address | Santa Fe, NM 87505-5600 |
Second Address | Santa Fe, NM 87505-5600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2020 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32D0653253 | CLIA (01) |