Healthcare Provider Details

I. General information

NPI: 1336370089
Provider Name (Legal Business Name): CHRISTINA MIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WAIALAE AVE SUITE 111
HONOLULU HI
96816-5319
US

IV. Provider business mailing address

4211 WAIALAE AVE SUITE 111
HONOLULU HI
96816-5319
US

V. Phone/Fax

Practice location:
  • Phone: 808-732-4377
  • Fax:
Mailing address:
  • Phone: 808-732-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT2350
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: