Provider Demographics
NPI:1669761383
Name:MIN, ELISE HYEYOUN (MD)
Entity type:Individual
Prefix:MISS
First Name:ELISE
Middle Name:HYEYOUN
Last Name:MIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:HYEYOUN
Other - Middle Name:
Other - Last Name:MIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13636 VENTURA BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 N BEDFORD DR STE 206
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4317
Practice Address - Country:US
Practice Address - Phone:310-751-5183
Practice Address - Fax:310-817-6352
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159791208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery