Healthcare Provider Details

I. General information

NPI: 1033547054
Provider Name (Legal Business Name): MINJUNG DOH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FL 3, 68, UJEONGGUKRO
JONGNO GU SEOUL
03145
KR

IV. Provider business mailing address

YONGSAN PARKTOWER BUILDLING 103 SUITE 402 YOUNGSAN DONG 5
YONGSAN SEOUL
140 762
KR

V. Phone/Fax

Practice location:
  • Phone: 822-692-9301
  • Fax: 822-525-0618
Mailing address:
  • Phone: 821075343013
  • Fax: 822-525-0618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number68 019875
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: