Healthcare Provider Details

I. General information

NPI: 1053196931
Provider Name (Legal Business Name): DA MOK MIN AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 02/28/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANCH HEALTH CLINIC (BHC) PARRIS ISLAND 670 BOULEVARD DE FRANCE
PARRIS ISLAND SC
29905
US

IV. Provider business mailing address

BRANCH HEALTH CLINIC (BHC) PARRIS ISLAND 670 BOULEVARD DE FRANCE
PARRIS ISLAND SC
29905
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-2528
  • Fax:
Mailing address:
  • Phone: 843-228-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: