Provider Demographics
NPI:1316167794
Name:MIN, PHILLIP SEOKKEE (D D S, M S)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:SEOKKEE
Last Name:MIN
Suffix:
Gender:M
Credentials:D D S, M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 748
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2756
Mailing Address - Country:US
Mailing Address - Phone:213-383-6363
Mailing Address - Fax:213-383-6365
Practice Address - Street 1:3660 WILSHIRE BLVD
Practice Address - Street 2:SUITE 748
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2756
Practice Address - Country:US
Practice Address - Phone:213-383-6363
Practice Address - Fax:213-383-6365
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics