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General NPI Number Information
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NPI Number | 1659826147
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Entity Type | Individual
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Provider Name | OLIVIA MIN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 02/17/2024
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Provider Practice Location Address
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Address Line | 2233 E GARVEY AVE N STE A
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City | WEST COVINA
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State | CA
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Zip | 91791-1500
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Country | US
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Telephone | 626-605-6201
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Fax |
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Provider Business Mailing Address
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Address Line | 5701 PARK DR UNIT 9306
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City | CHINO HILLS
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State | CA
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Zip | 91709-4958
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Country | US
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Telephone |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 109494
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 32342
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License Number State | TX
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