MEDICARE: MIKWAN 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1528464294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKWAN CORPORATION

Provider Business Mailing Address
First Line	:	15830 RAWHIDE LN
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-9521
Country	:	US
Telephone Number	:	818-808-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 INDIANA AVE
Second Line	:	SUITE 290-295
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4269
Country	:	US
Telephone Number	:	951-289-9968
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WIRLEY BAUMANN
Credential	:
Telephone Number	:	951-289-9968

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	01/18/2016

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