Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95011151 | CA |
NPI | 1093371478 |
---|---|
Provider Name | Fion Tai |
First Address | Tustin, CA 92782-6523 |
Second Address | Tustin, CA 92782-6523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2019 |
Last Update Date | 12/05/2019 |