Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | TRN10480 | FL |
Y | 207YS0123X | Facial Plastic Surgeon | 44925 | KY |
NPI | 1205088150 |
---|---|
Provider Name | Jessica Lee Kulak |
First Address | Cincinnati, OH 45242-5441 |
Second Address | Edgewood, KY 41017-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2008 |
Last Update Date | 23/03/2012 |