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General NPI Number Information
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NPI Number | 1093555070
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Entity Type | Individual
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Provider Name | MIN KEE JOSEPH AN
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Gender | Male
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 11748 MAGNOLIA AVE STE B
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City | RIVERSIDE
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State | CA
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Zip | 92503-4955
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Country | US
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Telephone | 951-440-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 MERCEDES AVE APT 21
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City | LOS ALTOS
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State | CA
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Zip | 94022-1150
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Country | US
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Telephone | 650-636-6325
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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