Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 20012 | MA |
NPI | 1104920586 |
---|---|
Provider Name | Mr. Paul Chae |
First Address | Puyallup, WA 98373 |
Second Address | Worcester, MA 01605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 24/08/2012 |