Provider Demographics
NPI:1902134588
Name:MINX MED
Entity Type:Organization
Organization Name:MINX MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:818-381-0401
Mailing Address - Street 1:10523 BURBANK BLVD
Mailing Address - Street 2:213
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2233
Mailing Address - Country:US
Mailing Address - Phone:818-509-9143
Mailing Address - Fax:818-509-9367
Practice Address - Street 1:10523 BURBANK BLVD
Practice Address - Street 2:213
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2233
Practice Address - Country:US
Practice Address - Phone:818-509-9143
Practice Address - Fax:818-509-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC75234208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC75234Medicare Oscar/Certification