Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 004765 | PA |
NPI | 1528023272 |
---|---|
Provider Name | Kim Y Yoo |
First Address | Melrose Park, PA 19027-3008 |
Second Address | Melrose Park, PA 19027-3008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01267589 | (05) | PA |