Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901600360 | MI |
NPI | 1003458126 |
---|---|
Provider Name | Elizabeth Hong Van |
First Address | Sterling Heights, MI 48312-5774 |
Second Address | Sterling Heights, MI 48312-5774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 09/10/2019 |