Provider Demographics
NPI:1184074429
Name:MIN, BYUNG HO
Entity type:Individual
Prefix:
First Name:BYUNG HO
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S GRAMERCY PL
Mailing Address - Street 2:305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4996
Mailing Address - Country:US
Mailing Address - Phone:213-249-1631
Mailing Address - Fax:
Practice Address - Street 1:2122 164TH ST SW
Practice Address - Street 2:203
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-7811
Practice Address - Country:US
Practice Address - Phone:425-245-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist