Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1033535653 |
---|---|
Provider Name | Kaleena Ma |
First Address | Forest Hills, NY 11375-4724 |
Second Address | Forest Hills, NY 11375-4724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2014 |
Last Update Date | 04/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03279398 | (05) | NY |