Healthcare Provider Details

I. General information

NPI: 1437588647
Provider Name (Legal Business Name): CHRISTOPHER BYUNGWOOK MIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BYUNGWOOK MIN PHD

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8481
  • Fax: 714-509-8756
Mailing address:
  • Phone: 714-509-8481
  • Fax: 714-509-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY26055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: