Provider Demographics
NPI:1508061011
Name:MIN, MICHELLE J (NP)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:J
Last Name:MIN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:11539 HAWTHORNE BLVD
Mailing Address - Street 2:STE. 6E
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2325
Mailing Address - Country:US
Mailing Address - Phone:310-531-2000
Mailing Address - Fax:310-531-2084
Practice Address - Street 1:4314 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2808
Practice Address - Country:US
Practice Address - Phone:310-531-2000
Practice Address - Fax:310-531-2084
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2021-09-14
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Provider Licenses
StateLicense IDTaxonomies
CANP15228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily