Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2019001864 | CA |
NPI | 1598361537 |
---|---|
Provider Name | Hun Min Koo |
First Address | Tamuning, GU 96913-4321 |
Second Address | Tamuning, GU 96913-4321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2020 |
Last Update Date | 06/12/2020 |