Provider Demographics
NPI:1447319900
Name:MIN, DEREK AUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:AUNG
Last Name:MIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 E ARROW HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702
Mailing Address - Country:US
Mailing Address - Phone:626-332-4788
Mailing Address - Fax:626-332-5388
Practice Address - Street 1:891 E ARROW HWY
Practice Address - Street 2:SUITE B
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702
Practice Address - Country:US
Practice Address - Phone:626-332-4788
Practice Address - Fax:626-332-5388
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist