Basic Information
| Provider Information | |||||||||
| NPI: | 1104237163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIN | ||||||||
| FirstName: | JI | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1050 | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170011050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177632126 | ||||||||
| FaxNumber: | 7179750799 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 N 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177632126 | ||||||||
| FaxNumber: | 7179750779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2014 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | OS019246 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.