Provider Demographics
NPI:1447619499
Name:THEIN, MIN SWE (MCW)
Entity Type:Individual
Prefix:
First Name:MIN SWE
Middle Name:
Last Name:THEIN
Suffix:
Gender:M
Credentials:MCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 E PACIFIC COAST HWY
Mailing Address - Street 2:SUIT 600
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3279
Mailing Address - Country:US
Mailing Address - Phone:562-346-1100
Mailing Address - Fax:562-961-7604
Practice Address - Street 1:4510 E PACIFIC COAST HWY
Practice Address - Street 2:SUIT 600
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3279
Practice Address - Country:US
Practice Address - Phone:562-346-1100
Practice Address - Fax:562-961-7604
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker