NPI | 1376767475 |
---|---|
Former Name | SARAH SOHYUN BONG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 00203802) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401411892) |
Enumeration Date | 2007-04-12 |
Last Update Date | 2023-01-06 |