Provider Demographics
NPI:1619226602
Name:MIN, HAE SUNG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HAE
Middle Name:SUNG
Last Name:MIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30340 HAUN RD
Mailing Address - Street 2:T2471
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-6806
Mailing Address - Country:US
Mailing Address - Phone:951-723-6151
Mailing Address - Fax:
Practice Address - Street 1:30340 HAUN RD
Practice Address - Street 2:T2471
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6806
Practice Address - Country:US
Practice Address - Phone:951-723-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist