Provider Demographics
NPI:1083342752
Name:MIN, DEBBIE JISOO
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:JISOO
Last Name:MIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 W ROWLAND CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2014
Mailing Address - Country:US
Mailing Address - Phone:714-349-0930
Mailing Address - Fax:
Practice Address - Street 1:2772 W ROWLAND CIR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2014
Practice Address - Country:US
Practice Address - Phone:714-349-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant