Provider Demographics
NPI:1194176354
Name:MIN, MICHELLE SE WON (MD, MSCI)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SE WON
Last Name:MIN
Suffix:
Gender:
Credentials:MD, MSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MED SURG I
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-0001
Mailing Address - Country:US
Mailing Address - Phone:949-824-0606
Mailing Address - Fax:
Practice Address - Street 1:118 MED SURG I
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-2907
Practice Address - Country:US
Practice Address - Phone:949-824-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268686207R00000X
CAA172462207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine