Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A118722 | CA |
Y | 208600000X | Surgeon | A118722 | CA |
NPI | 1013101633 |
---|---|
Provider Name | Wei Loong Glenn Koh |
First Address | Modesto, CA 95356-9718 |
Second Address | Modesto, CA 95356-9718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 13/02/2014 |