Provider Demographics
NPI:1437325941
Name:MIN-TUN, MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MIN-TUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39200 LIBERTY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1515
Mailing Address - Country:US
Mailing Address - Phone:510-790-1200
Mailing Address - Fax:510-790-2558
Practice Address - Street 1:55 EAST JULIAN STREET
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112
Practice Address - Country:US
Practice Address - Phone:408-918-2626
Practice Address - Fax:408-280-0672
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD321401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice