Provider Demographics
NPI:1780743823
Name:MIN, PAUL H (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:MIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14926 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6554
Mailing Address - Country:US
Mailing Address - Phone:206-364-6000
Mailing Address - Fax:
Practice Address - Street 1:14926 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6554
Practice Address - Country:US
Practice Address - Phone:206-364-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA 1937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMI0012OtherREGENCE
WA2016681Medicaid
WAA827335OtherPREMERA