Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 320360 | LA |
NPI | 1023438090 |
---|---|
Provider Name | Kim Tien Dinh |
First Address | West Monroe, LA 71291-4414 |
Second Address | West Monroe, LA 71291-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 30/07/2019 |