Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901021361 | MI |
NPI | 1003222472 |
---|---|
Provider Name | Minh-Phuong Isabelle Kieu |
First Address | Detroit, MI 48207-2821 |
Second Address | Detroit, MI 48208-2576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 10/07/2014 |