Healthcare Provider Details

I. General information

NPI: 1669761383
Provider Name (Legal Business Name): ELISE HYEYOUN MIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HYEYOUN MIN MD

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR STE 206
BEVERLY HILLS CA
90210-4317
US

IV. Provider business mailing address

13636 VENTURA BLVD STE 224
SHERMAN OAKS CA
91423-3700
US

V. Phone/Fax

Practice location:
  • Phone: 310-751-5183
  • Fax: 310-817-6352
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA159791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: