Healthcare Provider Details

I. General information

NPI: 1548820228
Provider Name (Legal Business Name): AUNG NAING MIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AUNG NAING MIN

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 10/27/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10990 SAN DIEGO MISSION RD
SAN DIEGO CA
92108-2417
US

IV. Provider business mailing address

10990 SAN DIEGO MISSION RD
SAN DIEGO CA
92108-2417
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-1245
  • Fax:
Mailing address:
  • Phone: 619-528-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA186115
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.074361
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036.159415
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: