Provider Demographics
NPI:1811480098
Name:MIN, KYUNGHWAN (DMD)
Entity type:Individual
Prefix:
First Name:KYUNGHWAN
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13920 RONALD W REAGAN BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1002
Mailing Address - Country:US
Mailing Address - Phone:737-777-6226
Mailing Address - Fax:
Practice Address - Street 1:13920 RONALD W REAGAN BLVD STE 210
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-1002
Practice Address - Country:US
Practice Address - Phone:737-777-6226
Practice Address - Fax:737-777-6220
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031716122300000X
TX38286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist