Provider Demographics
NPI:1861912909
Name:MIN, DAVID WAI (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAI
Last Name:MIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9528 CORTADA ST UNIT F
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1041
Mailing Address - Country:US
Mailing Address - Phone:626-679-3412
Mailing Address - Fax:
Practice Address - Street 1:323 E BULLARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8620
Practice Address - Country:US
Practice Address - Phone:559-439-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist