Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | AS2383278 | NY |
Y | 208200000X | Surgeon | 284575 | NY |
Y | 208600000X | Surgeon | 284575 | NY |
NPI | 1265745376 |
---|---|
Provider Name | Elijah Se Hong Min |
First Address | New York, NY 10016-6402 |
Second Address | Riverhead, NY 11901-1953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2010 |
Last Update Date | 11/09/2018 |