Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | LL40995 | SC |
NPI | 1023546231 |
---|---|
Provider Name | Quiana Lashon Kern |
First Address | Charleston, SC 29425 |
Second Address | Charleston, SC 29425-8905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2017 |
Last Update Date | 01/06/2017 |