Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 19641 | OK |
Y | 207T00000X | Neurosurgeon | 7915443-1205 | UT |
N | 207T00000X | Neurosurgeon | 8937A | WY |
NPI | 1053304204 |
---|---|
Provider Name | Wonhong David Min |
First Address | Salt Lake City, UT 84106-1496 |
Second Address | Salt Lake City, UT 84106-1496 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 11/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000177430A | (05) | OK |
H20964 | (02) | OK |