Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5957 | MA |
NPI | 1154763795 |
---|---|
Provider Name | Steve Yoon |
First Address | Allston, MA 02134-1030 |
Second Address | Allston, MA 02134-1030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 24/07/2013 |