Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 3188 | CA |
NPI | 1073722971 |
---|---|
Provider Name | Jonathan Tin Chee Lum |
First Address | Sacramento, CA 95827-2539 |
Second Address | Fairfield, CA 94534-9771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 24/07/2015 |