Provider Demographics
NPI:1982975116
Name:MIN, MUMU (DMD)
Entity Type:Individual
Prefix:DR
First Name:MUMU
Middle Name:
Last Name:MIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NUT TREE RD
Mailing Address - Street 2:SUITE #D
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-449-8808
Mailing Address - Fax:707-449-6303
Practice Address - Street 1:2611 NUT TREE RD
Practice Address - Street 2:SUITE #D
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-449-8808
Practice Address - Fax:707-449-6303
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics