Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 0101235229 | VA |
NPI | 1598823718 |
---|---|
Provider Name | Suzanne Kim Doud Galli |
First Address | Reston, VA 20190-5896 |
Second Address | Reston, VA 20190-5896 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |