Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | Q8268 | TX |
NPI | 1205157443 |
---|---|
Provider Name | Kevin L Ju |
First Address | Rockwall, TX 75032-7805 |
Second Address | Rockwall, TX 75032-7805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 04/08/2016 |