Provider Demographics
NPI:1013689413
Name:MIN, JANE H (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:H
Last Name:MIN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 WILSHIRE BLVD STE 409
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1206
Mailing Address - Country:US
Mailing Address - Phone:213-389-1004
Mailing Address - Fax:213-263-2131
Practice Address - Street 1:3130 WILSHIRE BLVD STE 409
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1206
Practice Address - Country:US
Practice Address - Phone:213-389-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist