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General NPI Number Information
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NPI Number | 1396637831
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Entity Type | Individual
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Provider Name | KYUNG UK MIN DMD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1500 JOHN F KENNEDY BLVD STE 1906
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1714
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Country | US
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Telephone | 215-709-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 MARKET ST # 1321
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City | PHILADELPHIA
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State | PA
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Zip | 19103-2903
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Country | US
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Telephone | 954-999-8933
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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 | DS045304
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License Number State | PA
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