Provider Demographics
NPI:1275179996
Name:MIN, DEFEI
Entity Type:Individual
Prefix:
First Name:DEFEI
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20812 LYCOMING ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3118
Mailing Address - Country:US
Mailing Address - Phone:626-715-3870
Mailing Address - Fax:
Practice Address - Street 1:15944 LOS SERRANOS COUNTRY CLUB DR STE 160
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3990
Practice Address - Country:US
Practice Address - Phone:909-606-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily