Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A37644 | CA |
NPI | 1023130630 |
---|---|
Provider Name | Mr. Youngkyu Peter Sheen |
First Address | San Diego, CA 92121-4227 |
Second Address | San Diego, CA 92121-4227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0186589 | (05) | OH |
C00950 | (02) |