Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 0083201 | NY |
NPI | 1265641328 |
---|---|
Provider Name | Viengsamay J Chamleunsouk |
First Address | Johnson City, NY 13790-1824 |
Second Address | Johnson City, NY 13790 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |