Provider Demographics
NPI:1497974521
Name:MIN-TUN, D.M.D., INC.
Entity Type:Organization
Organization Name:MIN-TUN, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIN-TUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-790-1200
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 1:39200 LIBERTY ST
Practice Address - Street 2:SUITE B
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1515
Practice Address - Country:US
Practice Address - Phone:510-790-1200
Practice Address - Fax:510-790-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty