Healthcare Provider Details

I. General information

NPI: 1982975116
Provider Name (Legal Business Name): MUMU MIN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 NUT TREE RD SUITE #D
VACAVILLE CA
95687
US

IV. Provider business mailing address

2611 NUT TREE RD SUITE #D
VACAVILLE CA
95687
US

V. Phone/Fax

Practice location:
  • Phone: 707-449-8808
  • Fax: 707-449-6303
Mailing address:
  • Phone: 707-449-8808
  • Fax: 707-449-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number38882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: