Provider Demographics
NPI:1982076519
Name:MIN, SEON YOUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEON YOUNG
Middle Name:
Last Name:MIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PARNASSUS AVE # UB10
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2208
Mailing Address - Country:US
Mailing Address - Phone:415-514-1678
Mailing Address - Fax:
Practice Address - Street 1:533 PARNASSUS AVE # UB10
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-514-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16147122300000X
DCDEN1001617122300000X
CA1024691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist