MEDICARE: OLIVE TREE NURSING CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1194698043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE TREE NURSING CORPORATION

Provider Business Mailing Address
First Line	:	1208 CORTE MENDI
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-3547
Country	:	US
Telephone Number	:	213-663-8836
Fax Number	:

Provider Business Practice Location Address
First Line	:	7227 BROADWAY STE 405
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1505
Country	:	US
Telephone Number	:	213-663-8836
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YOHAN HAN HWANG
Credential	:
Telephone Number	:	213-663-8836

Provider Enumeration Date	:	09/26/2025
Last Update Date	:	10/15/2025

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