Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60141899 | WA |
NPI | 1558663500 |
---|---|
Provider Name | Ms. Sofya V Kochubey |
First Address | Tacoma, WA 98407-1902 |
Second Address | Tacoma, WA 98407-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2010 |
Last Update Date | 31/01/2012 |