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General NPI Number Information
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NPI Number | 1043970957
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Entity Type | Individual
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Provider Name | AUDREY MIN
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Gender | Female
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 680 BANCROFT AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-2904
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Country | US
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Telephone | 510-569-0218
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Fax |
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Provider Business Mailing Address
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Address Line | 933 SHORELINE DR APT 206
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City | ALAMEDA
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State | CA
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Zip | 94501-5991
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Country | US
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Telephone | 213-330-5486
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 106684
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License Number State | CA
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