Provider Demographics
NPI:1992372056
Name:MIN, SUHJUN (DDS)
Entity Type:Individual
Prefix:
First Name:SUHJUN
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11417 SUNRISE LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5150
Mailing Address - Country:US
Mailing Address - Phone:952-607-8489
Mailing Address - Fax:
Practice Address - Street 1:500169
Practice Address - Street 2:SAIPAN SEVENTH-DAY ADVENTIST CLINIC
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP01701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice