Healthcare Provider Details

I. General information

NPI: 1205305992
Provider Name (Legal Business Name): HEUNGKI MIN DDS A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 BEACH BLVD
BUENA PARK CA
90621-2021
US

IV. Provider business mailing address

5881 BEACH BLVD
BUENA PARK CA
90621-2021
US

V. Phone/Fax

Practice location:
  • Phone: 714-266-0378
  • Fax: 714-266-0385
Mailing address:
  • Phone: 714-266-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HEUNGKI MIN
Title or Position: PRESIDENT
Credential:
Phone: 714-266-0378