Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | G64857 | CA |
NPI | 1235243999 |
---|---|
Provider Name | Jong Min Rho |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-2746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 15/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
874728 | (05) | AZ |
H28491 | (02) | AZ |