Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT003029 | GA |
NPI | 1013424936 |
---|---|
Provider Name | Kemeng Wang |
First Address | Doraville, GA 30340-6102 |
Second Address | Doraville, GA 30340-6102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2017 |
Last Update Date | 30/12/2017 |