Provider Demographics
NPI:1154399566
Name:MIN, JULIE EUNJEONG (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:EUNJEONG
Last Name:MIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EUNJEONG
Other - Middle Name:
Other - Last Name:MIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2846 S CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6618
Mailing Address - Country:US
Mailing Address - Phone:310-833-1257
Mailing Address - Fax:
Practice Address - Street 1:1251 W REDONDO BEACH BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3456
Practice Address - Country:US
Practice Address - Phone:310-851-4705
Practice Address - Fax:310-851-4719
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 517212 NP 12611363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology