Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D11729 | MN |
NPI | 1073558060 |
---|---|
Provider Name | Dr. Zongshi Ji |
First Address | Inver Grove Heights, MN 55077-4446 |
Second Address | Lakeville, MN 55044-7915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 08/07/2007 |