Provider Demographics
NPI:1982098976
Name:MIN, KEVIN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAY
Last Name:MIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:220 PONCE DE LEON PL UNIT 561
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3281
Mailing Address - Country:US
Mailing Address - Phone:408-406-6742
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON ROAD, NE
Practice Address - Street 2:3B SOUTH, EMORY UNIVERSITY HOSPITAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA080671207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology