Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 34878 | CA |
NPI | 1003583063 |
---|---|
Provider Name | Junyao Xu |
First Address | Rowland Heights, CA 91748-4651 |
Second Address | Fontana, CA 92335-3431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2021 |
Last Update Date | 26/08/2021 |