Provider Demographics
NPI:1790455319
Name:MIN, JI EUN
Entity Type:Individual
Prefix:
First Name:JI EUN
Middle Name:
Last Name:MIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 S GARFIELD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4796
Mailing Address - Country:US
Mailing Address - Phone:626-427-1779
Mailing Address - Fax:626-466-3886
Practice Address - Street 1:1118 S GARFIELD AVE STE 202
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4796
Practice Address - Country:US
Practice Address - Phone:626-427-1779
Practice Address - Fax:626-466-3886
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist