Provider Demographics
NPI:1932704319
Name:MIN CLINIC CORPORATION
Entity Type:Organization
Organization Name:MIN CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:626-701-8666
Mailing Address - Street 1:18710 AMAR RD STE B
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4571
Mailing Address - Country:US
Mailing Address - Phone:626-701-8666
Mailing Address - Fax:
Practice Address - Street 1:18710 AMAR RD STE B
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4571
Practice Address - Country:US
Practice Address - Phone:626-701-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty