Basic Information
| Provider Information | |||||||||
| NPI: | 1659684165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIN | ||||||||
| FirstName: | INSUNG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 LESLIE LN | ||||||||
| Address2: | |||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194222152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159173446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16 E 16TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126330800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2010 | ||||||||
| LastUpdateDate: | 07/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD440605 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.