Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DD4773 | NM |
NPI | 1003331984 |
---|---|
Provider Name | Jonathan Hsi |
First Address | Schaumburg, IL 60173-4166 |
Second Address | Los Lunas, NM 87031-4891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2017 |
Last Update Date | 11/08/2017 |