Healthcare Provider Details

I. General information

NPI: 1609177120
Provider Name (Legal Business Name): MICHELLE GINAH SON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE GINAH YUN OD

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 DURHAM CHAPEL HILL BLVD
DURHAM NC
27707-2516
US

IV. Provider business mailing address

116 EDWARD BOOTH LN
DURHAM NC
27713-9675
US

V. Phone/Fax

Practice location:
  • Phone: 919-246-9545
  • Fax: 919-246-9545
Mailing address:
  • Phone: 714-403-0125
  • Fax: 919-246-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2217
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: