Healthcare Provider Details

I. General information

NPI: 1790853208
Provider Name (Legal Business Name): BUMJIN STEVE MIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-5318
US

IV. Provider business mailing address

23 SADDLEVIEW CT
NORTH POTOMAC MD
20878-3861
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4959
  • Fax: 301-319-2420
Mailing address:
  • Phone: 301-717-7859
  • Fax: 301-319-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101233794
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number0101233794
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: