Individual
HONG U. ISHAKU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2904 CRESTLINE DR, LAWRENCE, KS 66047-3065
(785) 832-1360
Mailing address
2904 CRESTLINE DR, LAWRENCE, KS 66047-3065
(785) 832-1360
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
KSA75-3307B
KS
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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