MEDICARE: SO YOUN MIN DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1336008457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SO YOUN MIN DDS INC

Provider Business Mailing Address
First Line	:	18102 IRVINE BLVD STE 201
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3424
Country	:	US
Telephone Number	:	714-730-9656
Fax Number	:	714-730-9678

Provider Business Practice Location Address
First Line	:	18102 IRVINE BLVD STE 201
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-3424
Country	:	US
Telephone Number	:	714-730-9656
Fax Number	:	714-730-9678

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SO YOUN MIN
Credential	:	DDS
Telephone Number	:	714-730-9656

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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