Individual provider Active NPI

Phillip Seokkee Min, D. D. S., M. S.

  • Endodontics
  • Los Angeles, CA
National Provider Identifier
1316167794
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
39310 Issued in CA
Practice address
3660 Wilshire Blvd
Suite 748
Los Angeles, CA 90010-2756
Phone
(213) 383-6363
Fax
(213) 383-6365
NPI assigned
Apr 26, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 39310 CA Primary

Addresses

Primary practice location

3660 Wilshire Blvd
Suite 748
Los Angeles, CA 90010-2756

Mailing address

3660 Wilshire Blvd
Suite 748
Los Angeles, CA 90010-2756
Phone (213) 383-6363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161007001701 CA Order and Referring Only - DentistPractitioner - Dentist 5193013076

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
39310CAMDEndodontist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316167794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 WILSHIRE BLVD",
            "address_2": "SUITE 748",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102756",
            "telephone_number": "213-383-6363",
            "fax_number": "213-383-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 WILSHIRE BLVD",
            "address_2": "SUITE 748",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102756",
            "telephone_number": "213-383-6363",
            "fax_number": "213-383-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIN",
        "first_name": "PHILLIP",
        "middle_name": "SEOKKEE",
        "name_prefix": "Dr.",
        "credential": "D. D. S., M. S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "39310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.