Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 050624 | CT |
N | 207RG0100X | Gastroenterologist | 239729 | NY |
NPI | 1003823683 |
---|---|
Provider Name | Kevin Jo |
First Address | Rocky Hill, CT 06067-2336 |
Second Address | Meriden, CT 06451-2121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 01/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008039309 | (05) | CT |