Healthcare Provider Details

I. General information

NPI: 1508735747
Provider Name (Legal Business Name): MICHELLE MIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 ROSSMOOR PKWY
WALNUT CREEK CA
94595-2538
US

IV. Provider business mailing address

1873 W TRAVERSE PKWY STE E100
LEHI UT
84048-5985
US

V. Phone/Fax

Practice location:
  • Phone: 801-215-9309
  • Fax:
Mailing address:
  • Phone: 801-215-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: