Healthcare Provider Details

I. General information

NPI: 1295265171
Provider Name (Legal Business Name): MIN BAHK PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 S LA FAYETTE PARK PL APT 304
LOS ANGELES CA
90057-1337
US

IV. Provider business mailing address

249 S LA FAYETTE PARK PL APT 304
LOS ANGELES CA
90057-1337
US

V. Phone/Fax

Practice location:
  • Phone: 213-926-8930
  • Fax:
Mailing address:
  • Phone: 213-926-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1372257
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51391
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000027143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: