Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35126662 | OH |
N | 207ND0101X | MOHS-Micrographic Surgeon | 35126662 | OH |
NPI | 1326332792 |
---|---|
Provider Name | Llana Pootrakul |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43221-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2011 |
Last Update Date | 01/03/2021 |