Provider Demographics
NPI:1821384868
Name:MUNDSCHENK, MINH-BAO (MD)
Entity Type:Individual
Prefix:DR
First Name:MINH-BAO
Middle Name:
Last Name:MUNDSCHENK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MINH-BAO
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2025 MORSE AVENUE
Mailing Address - Street 2:PLASTIC SURGERY, SUITE 2E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2115
Mailing Address - Country:US
Mailing Address - Phone:916-936-7109
Mailing Address - Fax:
Practice Address - Street 1:ALREADY LISTED AS 1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-1010
Practice Address - Country:US
Practice Address - Phone:618-520-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA157179208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1831384868Medicaid