Healthcare Provider Details

I. General information

NPI: 1053232256
Provider Name (Legal Business Name): MINT MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BROADWAY RM 2403
NEW YORK NY
10018-0101
US

IV. Provider business mailing address

1441 BROADWAY RM 2403
NEW YORK NY
10018-0101
US

V. Phone/Fax

Practice location:
  • Phone: 212-201-1043
  • Fax:
Mailing address:
  • Phone: 212-201-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARIM KIM
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 781-382-4460