Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 64014 | CA |
NPI | 1033513114 |
---|---|
Provider Name | Hyun Ji Sophia Kang |
First Address | Valencia, CA 91381-0611 |
Second Address | Loma Linda, CA 92350-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 17/10/2014 |