Provider Demographics
NPI:1780691113
Name:MIN, JUM K (MD)
Entity type:Individual
Prefix:
First Name:JUM
Middle Name:K
Last Name:MIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 SAN DIMAS ST STE A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1205
Mailing Address - Country:US
Mailing Address - Phone:661-324-4714
Mailing Address - Fax:
Practice Address - Street 1:4050 SAN DIMAS
Practice Address - Street 2:# A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-324-4714
Practice Address - Fax:661-324-7971
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313770Medicare ID - Type Unspecified
CAA26456Medicare UPIN