Healthcare Provider Details

I. General information

NPI: 1861912909
Provider Name (Legal Business Name): DAVID WAI MIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E BULLARD AVE STE 103
FRESNO CA
93710-8620
US

IV. Provider business mailing address

9528 CORTADA ST UNIT F
EL MONTE CA
91733-1041
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-9998
  • Fax:
Mailing address:
  • Phone: 626-679-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number101425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: