Provider Demographics
NPI:1497161558
Name:JAE HONG MIN, M.D.,P.C.
Entity Type:Organization
Organization Name:JAE HONG MIN, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:MIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-353-5300
Mailing Address - Street 1:3409 MURRAY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3948
Mailing Address - Country:US
Mailing Address - Phone:718-353-5300
Mailing Address - Fax:
Practice Address - Street 1:3409 MURRAY ST FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3948
Practice Address - Country:US
Practice Address - Phone:718-353-5300
Practice Address - Fax:718-353-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty