| NPI | 1447631486 |
|---|---|
| Former Name | YIXUAN GONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 12540) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058587) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2020-06-09 |