Provider Demographics
NPI:1508119736
Name:MINN, CHARLES K (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:MINN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-272-5881
Mailing Address - Fax:253-383-0161
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:STE 107
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-272-5881
Practice Address - Fax:253-383-0161
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2022-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP7514207R00000X, 207RN0300X
WAMD60566032207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA349638OtherSTATE L&I
WAG8945405Medicare PIN