Provider Demographics
NPI:1437588647
Name:MIN, CHRISTOPHER BYUNGWOOK (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BYUNGWOOK
Last Name:MIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BYUNGWOOK
Other - Middle Name:
Other - Last Name:MIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-509-8481
Mailing Address - Fax:714-509-8756
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-509-8481
Practice Address - Fax:714-509-8756
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26055103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent