Search › California › 1223X0400X
Tae Kwon
NPI 1992157572 · on the registry since 2016
Practice
- Address
- 1161 E Shepherd Ave Apt 201
Fresno, CA 93720 - Phone
- (310) 890-0816
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 1223X0400X
1223X0400X
- Also registered as
- 390200000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-07-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California