Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME123493 | FL |
NPI | 1235367483 |
---|---|
Provider Name | Seung Jin Yi |
First Address | Temple Terrace, FL 33637-0925 |
Second Address | Tampa, FL 33625-4013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 09/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014890300 | (05) | FL |
150W5 | FLORIDA BLUE (01) | FL |